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At least 829 records · Page 46Linked to original sources

PubMed2006

Breast conservation surgery without pre-operative mammography--a definite feasibility.

Mammography is mandatory before breast conservation. Its limited availability in developing countries has discouraged surgeons in rural areas from practicing breast conservation. We analyzed the database of breast surgeries at our institute to investigate whether breast conservation could be safely performed if clinically feasible without the use of mammography. If mammography had not been performed in the 735 patients undergoing surgery, breast conservation could have been erroneously performed in 38 (5.17%) patients; 13 had impalpable mammographic multicentricity and 25 had extensive microcalcifications. A detailed analysis showed that this error in decision would have been detected and rectified in each of the above patients before commencement of radiotherapy. We conclude that although mammography cannot be totally excluded from the treatment algorithm for palpable breast cancer, conservative surgery can be offered in clinically suitable cases even if pre-operative mammography is not available due to limited resources in the developing world.

Breast Neoplasms↗

PubMed2004

[Breast-conserving therapy of breast cancer].

Breast-conserving treatment for breast cancer combines lumpectomy, axillary nodes treatment and radiotherapy of the breast. Conservative surgery and radiotherapy is now the standard treatment for unifocal, non inflammatory tumors, less than 3 cm in diameter. The widespread use of mammographic screening leads to a significant increase in the proportion of non palpable breast carcinomas, and has contributed to increase the proportion of breast conserving treatments. Neoadjuvant treatments (chemotherapy, radiotherapy and hormonotherapy) can also extend the indications of breast conservation to breast carcinomas larger than 3 cm. Furthermore, in the last ten years, new surgical procedures (sentinel node biopsy, oncoplastic surgery, minimal invasive surgery) have been developed, increasing the surgical possibilities. After a learning phase to establish new standards for these procedures, all these techniques are now part of our standard surgical apparel, thus extending the possibilities of breast conserving surgery.

Adult↗

PubMed2004

Enoxaparin versus unfractionated heparin in patients treated with tirofiban, aspirin and an early conservative initial management strategy: results from the A phase of the A-to-Z trial.

AIMS: In high risk patients with non-ST elevation acute coronary syndromes (ACS), enoxaparin is generally preferred to unfractionated heparin (UFH). However, less is known about the relative merits of these two forms of heparin in patients receiving concomitant glycoprotein IIb/IIIa inhibitors. METHODS AND RESULTS: The A phase of the A-to-Z trial was an open label non-inferiority trial in which 3987 patients with non-ST elevation ACS were randomised to receive either enoxaparin or UFH in combination with aspirin and tirofiban. Inclusion required either ST depression or cardiac biomarker elevation. While the selection of an early management strategy (invasive or conservative) was at the discretion of the local investigator, investigators were asked to designate their plans for an invasive or conservative strategy on the case record form. An early conservative strategy was specified for 1778 patients (45%); this subgroup forms the population for the present analyses. Among patients with a planned conservative strategy, baseline characteristics were similar between those randomised to UFH (n = 872) and those randomised to enoxaparin (n = 906). The primary endpoint of death, new MI, or documented refractory ischaemia within 7 days of randomisation occurred in 10.6% of patients randomised to UFH and 7.7% of patients randomised to enoxaparin (HR 0.72; 95% CI 0.53-0.99; p = 0.04). The combined rate of TIMI major, minor, or loss no-site bleeding was 1.3% in patients treated with UFH and 1.8% in those treated with enoxaparin (p = ns). CONCLUSIONS: When a conservative approach to catheterisation and PCI was planned for ACS patients receiving tirofiban and aspirin, enoxaparin was associated with superior efficacy and similar bleeding vs UFH.

Aspirin↗

PubMed2005

Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies.

The aim of this study was to evaluate prognostic factors for isolated loco-regional recurrence in patients treated for invasive stage I or II breast cancer. The study population comprised 3602 women who had undergone primary surgery for early stage breast cancer, who were enrolled in European Organisation for Research and Treatment of Cancer (EORTC) trials 10801, 10854, or 10902, by breast conservation (55%) and mastectomy (45%). The median follow-up time varied from 5.3 (range: 0.6-9.5) to 11.9 years (range: 0.6-17.4). Main outcome was the occurrence of isolated loco-regional recurrence. The results of multivariate analysis showed that younger age and breast conservation were risk factors for isolated loco-regional recurrence (breast cancer under 35 years of age versus over 50 years of age: hazard ratio 2.80 (95% CI 1.41-5.60)); breast cancer age 35-50 years versus over 50 years: hazard ratio 1.72 (95% CI 1.17-2.54); breast conservation (hazard ratio: 1.82 (95% CI 1.17-2.86)). After perioperative chemotherapy, less isolated loco-regional recurrences were observed (hazard ratio 0.63 (95% CI 0.44-0.91)). No significant interaction effects were observed. It is concluded that young age and breast conserving therapy are both independent predictors for isolated loco-regional recurrence. As an isolated loco-regional recurrence is a potentially curable condition, women treated with breast conservation or diagnosed with breast cancer at a young age should be monitored closely to detect local recurrence at an early stage.

Adult↗

PubMed2005

Oncological and cosmetic outcomes of oncoplastic breast conserving surgery.

BACKGROUND: Breast-conserving surgery and radiotherapy is firmly established as a good and safe option for most women with early breast cancer. The important outcome measures of breast conservation are survival, local recurrence, cosmesis and patient satisfaction. Partial breast reconstructive techniques may improve cosmesis and patient satisfaction without compromising the oncological outcomes. METHODS: A search of the Medline and Pubmed databases of studies on breast conserving surgery where partial breast reconstructive techniques were employed. The keywords used were breast conserving surgery, oncoplastic breast surgery, partial breast reconstruction and reduction mammoplasty. The oncological and cosmetic outcomes of these studies were analysed. RESULTS: Studies on partial breast reconstructive techniques often lack oncological outcomes and long-term results are not available. On intermediate follow-up (up to 4.5 years) local recurrence rates vary from 0 to 1.8% per year. Cosmetic failure rates vary from 0 to 18%. To date, detailed studies are small and outcome measures vary. CONCLUSIONS: Breast surgeons should be aware of the range of surgical techniques that may enhance the aesthetic results of breast-conserving surgery as well as expand the indications for its use. There is a need for routine assessment of oncological and cosmetic outcomes and long-term results of partial breast reconstructive techniques in relation to these outcomes are awaited.

Breast Neoplasms↗

PubMed2005

Evolutionary conservation and mutational spectrum of BMPR2 gene.

A variety of mutations in the bone morphogenetic protein receptor type 2 (BMPR2) have been identified in patients with pulmonary arterial hypertension. In this study, using our BMPR2 mutation database and BMPR-II protein sequences from eight distantly related species, we defined the relationship among evolutionary conservation, mutation frequency and mutation distribution. As a whole, BMPR2 is evolving slower than the average for mammalian protein-encoding genes. As expected, the kinase domain is evolving more slowly than the extracellular ligand-binding and C-terminal domains. A detailed map of evolutionary conservation shows that there are repeating peaks and valleys within the C-terminal domain, representing higher and lower evolutionary conservation. We observed a strong correlation between evolutionary conservation and the distribution of mutations along the gene. All except two, of the nineteen missense mutations occur in absolutely conserved amino acids among the vertebrate homologs. In addition, we identified six mutational hotspots (P<0.05) by comparing the observed distribution of mutations to the pattern expected from a random multinomial distribution. Furthermore, analysis of the sequence environment surrounding the mutations revealed a specific pattern of mutagenesis. Over 22% of all single base-paired substitutions and 30% of all deletions and insertions are situated within tandem or non-tandem direct repeats of at least 5-bp and may be explained by slipped-mispairing model of mutagenesis. Also, over 59% of single base-paired substitutions versus 20% of deletions and insertions are located in perfect palindromic sequences that could produce "hairpin-loop" secondary structures with relatively high thermodynamic stability under physiological conditions. In addition, 3.7% of single base-paired substitutions versus 30% of deletions and insertions are located either within or in close proximity to the Krawczak and Cooper consensus sequence (TG A/G A/G G/T A/C). Further study of the mechanism of mutagenesis in BMPR2 may help identify other potentially mutable sites and differentiate between deleterious mutations and harmless polymorphic variants.

Amino Acid Sequence↗

PubMed2004

Protein-protein interactions: hot spots and structurally conserved residues often locate in complemented pockets that pre-organized in the unbound states: implications for docking.

Energetic hot spots account for a significant portion of the total binding free energy and correlate with structurally conserved interface residues. Here, we map experimentally determined hot spots and structurally conserved residues to investigate their geometrical organization. Unfilled pockets are pockets that remain unfilled after protein-protein complexation, while complemented pockets are pockets that disappear upon binding, representing tightly fit regions. We find that structurally conserved residues and energetic hot spots are strongly favored to be located in complemented pockets, and are disfavored in unfilled pockets. For the three available protein-protein complexes with complemented pockets where both members of the complex were alanine-scanned, 62% of all hot spots (DeltaDeltaG>2kcal/mol) are within these pockets, and 60% of the residues in the complemented pockets are hot spots. 93% of all red-hot residues (DeltaDeltaG>/=4kcal/mol) either protrude into or are located in complemented pockets. The occurrence of hot spots and conserved residues in complemented pockets highlights the role of local tight packing in protein associations, and rationalizes their energetic contribution and conservation. Complemented pockets and their corresponding protruding residues emerge among the most important geometric features in protein-protein interactions. By screening the solvent, this organization shields backbone hydrogen bonds and charge-charge interactions. Complemented pockets often pre-exist binding. For 18 protein-protein complexes with complemented pockets whose unbound structures are available, in 16 the pockets are identified to pre-exist in the unbound structures. The root-mean-squared deviations of the atoms lining the pockets between the bound and unbound states is as small as 0.9A, suggesting that such pockets constitute features of the populated native state that may be used in docking.

Models, Molecular↗

PubMed2006

Optimal duration of conservative treatment for lumbar disc herniation depending on the type of herniation.

Six hundred and six clinical records of patients who were admitted to the Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Nagano, Japan, due to lumbar disc herniation (LDH) between 1991 and 2002 were reviewed to determine the ideal conservative treatment period in relation to different types of LDH: contained and non-contained. Since 1997, we have prolonged in-hospital conservative treatment over a few weeks, which resulted in a decrease in the number of surgeries for non-contained LDH, especially of surgeries performed within 1 month. The number of surgeries for contained LDH did not decrease. The preoperative period of non-contained LDH was significantly shorter than that of contained LDH. These results indicate that for patients who have non-contained LDH, intensive conservative treatment may avoid a surgical procedure. For those patients who have contained LDH, conservative treatment should not be prolonged. We believe that the optimal duration of intensive conservative therapy should be less than 1 month.

Adolescent↗

PubMed2006

Conservative management of necrotizing fascitis in children.

BACKGROUND: Necrotizing fascitis (NF) is a severe infection of the subcutaneous tissue and fascia affecting children and adults. Conventional management includes resuscitation, aggressive debridement of necrotic tissue, and sometimes, additional measures such as hyperbaric oxygen and immunoglobulin therapy. This paper reports conservative management of 18 patients with NF with minimal morbidity and mortality. MATERIAL AND METHODS: Patients with NF admitted to our department between January 2000 and February 2004 were included in the study (N = 18). In all cases, the presentation was rapidly progressing cellulitis progressing to cutaneous gangrene between 6 and 18 hours. The patients were managed by aggressive fluid resuscitation, analgesia, broad-spectrum antibiotics, and dressing with liberal quantities of povidone iodine ointment. After separation of the gangrenous skin margins from the surrounding healthy tissue between 24 and 72 hours, dead skin and fascia were removed with forceps on the ward, the wound washed with liberal quantities of water, and the ointment dressing reapplied. This procedure was repeated until all the dead tissue had been removed. Once the wound was granulating, dressings were changed at increasing intervals until healing took place by secondary intention. RESULTS: The patients were aged between 5 days and 11 years. In all, NF began as a small boil progressing to a rapidly spreading cellulitis. None of the patients was operated during the acute stage of the infection. Blackening of the skin and separation of the edges occurred within 8-72 hours, the dead tissue was allowed to separate from the granulating base and could be removed at the bedside with minimal blood loss. Blood transfusion was required only in 2 patients where hemoglobin was < 9 gm/dL. Of the 18 patients, 6 grew group A streptococci and staphylococci in a polymicrobial wound culture, whereas the other 12 had polymicrobial flora without streptococci. The clinical course and outcomes were similar in both types of wounds. There was 1 death in the study group, and 1 patient required skin grafting. All other survivors had healing by secondary intention without disability. The period for complete epithelization varied between 3 and 8 weeks. Patients were discharged home when 70% of the wound had healed. There was extensive scarring in 3 children with NF involving the back. The other children had minimal or no scarring. None of the patients had any restriction in the movement of limbs or joints. These findings were compared with 16 retrospective patients of NF treated before January 2000 by the conventional approach of aggressive early debridement, the results of the conservative approach were superior with shorter hospital stay, lower number of blood transfusions, earlier appearance of granulation tissue, and shorter duration of complete healing. CONCLUSIONS: We conclude that the conservative management of NF offers advantages in morbidity without compromising the outcome. In our hospital setup, conservative treatment was less expensive and easily carried out. We would therefore advocate conservative management for the treatment of this condition.

Analgesia↗

PubMed2004

Protein-protein interactions; coupling of structurally conserved residues and of hot spots across interfaces. Implications for docking.

Hot spot residues contribute dominantly to protein-protein interactions. Statistically, conserved residues correlate with hot spots, and their occurrence can distinguish between binding sites and the remainder of the protein surface. The hot spot and conservation analyses have been carried out on one side of the interface. Here, we show that both experimental hot spots and conserved residues tend to couple across two-chain interfaces. Intriguingly, the local packing density around both hot spots and conserved residues is higher than expected. We further observe a correlation between local packing density and experimental deltadeltaG. Favorable conserved pairs include Gly coupled with aromatics, charged and polar residues, as well as aromatic residue coupling. Remarkably, charged residue couples are underrepresented. Overall, protein-protein interactions appear to consist of regions of high and low packing density, with the hot spots organized in the former. The high local packing density in binding interfaces is reminiscent of protein cores.

Alanine↗

PubMed2006

Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy).

OBJECTIVES: To report the long-term survival probability in more than 3000 men with localized prostate cancer treated either conservatively or by definitive treatment (radiotherapy or radical prostatectomy). METHODS: We studied 3159 men with biopsy-confirmed, clinically localized prostate cancer diagnosed from 1980 to 1997. We restricted our analysis to men 75 years of age or younger. The extent of comorbid disease was measured using the Charlson score. The Cox proportional hazards regression model was used to compare long-term survival in patients who were treated conservatively versus survival in patients treated with either radiotherapy or radical prostatectomy. RESULTS: After adjusting for age, race, tumor grade, comorbid disease, income status, and year of diagnosis, the overall survival rate at 15 years was 35% for conservative management, 50% for radiotherapy, and 65% for radical prostatectomy. The corresponding prostate cancer-specific survival rates were 79%, 87%, and 92%. Patients undergoing radiotherapy or radical prostatectomy had lower overall mortality than patients undergoing conservative management (adjusted relative risk 0.67 for radiotherapy and 0.41 for prostatectomy; P <0.001). The increase in the survival duration was 4.6 years with radiotherapy and 8.6 years with radical prostatectomy. CONCLUSIONS: The results of this study have shown that compared with conservative management, both radiotherapy and radical prostatectomy increase survival for men with localized prostate cancer.

Aged↗

PubMed2004

Expression and function of conserved nuclear receptor genes in Caenorhabditis elegans.

The Caenorhabditis elegans genome encodes 284 nuclear receptor (NR) genes. Among these 284 NR genes are 15 genes conserved among the Metazoa. Here, we analyze the expression and function of eight heretofore uncharacterized conserved C. elegans NR genes. Reporter gene analysis demonstrates that these genes have distinct expression patterns and that a majority of the C. elegans cell types express a conserved NR gene. RNA interference with NR gene function resulted in visible phenotypes for three of the genes, revealing functions in various processes during postembryonic development. Five of the conserved NR genes are orthologs of NR genes that function during molting and metamorphosis in insects. Functional studies confirm a role for most of these 'ecdysone cascade' NR orthologs during the continuous growth and dauer molts. Transcript levels for these genes fluctuate in a reiterated pattern during the molting cycles, reminiscent of the expression hierarchy observed in the insect ecdysone response. Together, these analyses provide a foundation for further dissecting the role of NRs in nematode development as well as for evaluating conservation of NR functions among the Metazoa.

Animals↗

PubMed2005

Fertility and recurrence results of conservative surgery for borderline ovarian tumors.

OBJECTIVES: To evaluate the fertility and recurrence outcomes in women treated with fertility-sparing surgery for borderline ovarian tumors. METHODS: A total of 142 patients with borderline ovarian tumors managed surgically from 1993 to 2004 were identified from gynecologic oncology and pathology files of SSK Ankara Maternity and Women's Health Teaching Hospital. Sixty-two of those patients who had conservative surgery were eligible for the study. Information was acquired by retrospective medical record review and patient interview. RESULTS: The observed recurrence rates after radical and fertility-sparing surgery were 0.0% and 6.5%, respectively. Four patients from the conservative surgery group developed recurrence, in contrast to none of the patients from the non-conservative surgery group. No disease-related deaths occurred in any group. In the conservatively managed group, ten women had successful pregnancies, with a total of 10 live births and 3 abortions. The mean duration of follow-up for the conservative surgery group was 44.3 months (range, 3-128). CONCLUSION: Fertility-sparing surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility. Recurrence is noted significantly more often after this type of treatment and close follow-up is needed to detect recurrent disease.

Adolescent↗

PubMed2005

Conservative surgery for borderline ovarian tumors: a review.

OBJECTIVE: Borderline tumor of the ovary is an epithelial tumor with a low rate of growth and a low potential to invade or metastasize. This review will outline the most recent information regarding the molecular pathogenesis, pathology, fertility and tumor recurrence rate after conservative management of young women with early-stage borderline ovarian tumors. METHODS: We performed a MEDLINE literature search of relevant clinical trials for the scope of this review that evaluated conservative treatment of borderline ovarian tumors for young women with low-stage disease who wish to preserve their fertility. RESULTS: Recently, investigators have begun to identify subsets of patients with a worse prognosis, such as patients with aneuploid tumors. A number of oncogenes are under investigation to determine their role in the pathogenesis of borderline ovarian tumors. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Laparoscopic treatment of adnexal masses has proved to be a safe and effective diagnostic and therapeutic tool in the hands of experienced laparoscopists. For women who are treated conservatively, follow-up is important. Surgery remains the most effective therapy for later stage lesions. Adjuvant therapy for advanced stage of borderline ovarian tumors remains controversial. CONCLUSION: Conservative management of borderline ovarian tumors is an appropriate therapeutic option for young women with early-stage lesions who wish to preserve their childbearing potential. Available data indicate that in these patients fertility, pregnancy outcome and survival remain excellent.

Female↗

PubMed2006

Conservative treatment of reproductive and sexual function in young woman with squamous carcinoma of the vagina.

OBJECTIVE: Primary squamous carcinoma of the vagina in young woman is extremely rare. Conservative management of both sexual and reproductive function poses challenging problems to gynecologic oncologists. METHODS: Between January 2001 and December 2004, four women under 40, nulliparous, with squamous cell carcinoma of the upper third of the vagina, at FIGO Stage I were submitted to conservative surgery of the reproductive/sexual function at our Institution. After written informed consent was obtained, conservative surgical treatment consisting of radical tumorectomy with pelvic lymphadenectomy, in three patients, and partial hemi-vaginectomy plus homolateral paracolpectomy/parametrectomy with pelvic lymphadenectomy, in the forth patient, was carried out. RESULTS: Mean operative time of conservative surgical treatment was 161 min. No intraoperative or postoperative complications were observed. In one patient, definitive pathologic examination revealed microscopic involvement of the paracolpium. Thus, after carrying out laparoscopic ovarian transposition, adjuvant radiotherapy (RT), consisting of pulsed-dose rate brachytherapy and external RT, was delivered in this woman. After a follow-up time of 51, 45, 21 and 9 months, respectively, all patients are regularly menstruating, sexually active and clinically free of disease. CONCLUSION: To our knowledge, this is the first report showing the feasibility and the efficacy of conservative surgery of reproductive and sexual function in young woman with vaginal carcinoma. A larger number of patients and a longer follow-up are needed to validate the safety of this approach.

Adult↗

PubMed2006

Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study.

OBJECTIVES: To examine outcomes in women treated with conservative surgery for borderline ovarian tumor in a large population-based cohort with long-term follow-up. METHODS: Women treated by conservative surgery for borderline tumor of the ovary from 1982-2004 within a large HMO setting were identified using electronic and tumor registry data. Chart review was performed when electronic data were incomplete. The indications for and outcomes from any subsequent gynecologic surgery and the risk of recurrent ovarian borderline and malignant tumor were determined. Risk factors for recurrence were analyzed using multivariate regression. RESULTS: Among one hundred and ninety-three patients identified, the average age was 33 (12-95), with 97% having apparent Stage I disease. Patients were followed with remaining ovarian tissue in situ for a mean of 6.9 years, with 59 women having 10 or more years of such observation. There were 21 recurrences with borderline tumor (11%) with a median time to first recurrence of 4.7 years; women treated by cystectomy recurred three times more often compared to women treated by oophorectomy (23% versus 7%). Two patients (1%) recurred with malignant disease involving remaining ovarian tissue, both within the first 3 years after surgery, with one death due to recurrence. During long-term follow-up, 19% of patients eventually underwent complete removal of ovarian tissue: in 8%, the surgery was prophylactic, in 5%, surgery was done for benign pathology, and in 6% for recurrent disease. CONCLUSIONS: In this population-based HMO setting, 11% of women treated with conservative surgery for borderline tumor recurred; however, half of these recurrences were successfully managed by repeat conservative surgery, with only 6% of women overall needing eventual complete removal of ovaries for recurrent disease. Patients treated by cystectomy were three times more likely to recur than those treated by oophorectomy. Malignant recurrences were rare, and while borderline recurrences often occurred more than 3 years after initial surgery, late malignant recurrences were not observed. These favorable long-term outcomes provide support for conservative surgery for these women.

Adolescent↗

PubMed1996

The management of placenta percreta: conservative and operative strategies.

OBJECTIVE: Our purpose was to assess preferences for the management of placenta percreta and identify aspects of care related to an improved outcome. STUDY DESIGN: Both an analysis of a questionnaire issued to members of the Society of Perinatal Obstetricians and a retrospective study at our institution were used to obtain case histories of women with placenta percreta during a recent 3-year period. RESULTS: Fifty-five of the 109 cases (50%) reported by members of the Society of Perinatal Obstetricians were suspected ante partum. Complications associated with this disorder included uterine rupture (3 cases), transfusion of > 10 units (44 cases, 40%), ureteral ligation or fistula formation (5 cases each, 5%), infection (31 cases, 28%), perinatal death (10 cases, 9%), and maternal death (8 cases, 7%). Management options included surgical removal of the uterus and involved tissues (101 cases, 93%) and conservative treatment with the placenta left in situ after delivery (8 cases, 7%). More members of the Society of Perinatal Obstetricians responding to our survey opted for conservative management if adjacent tissues were involved (69% with extension into the bladder or gastrointestinal tract) compared with 31% when the percreta was confined to the uterus, p < 0.001. Conservative therapy was also associated with less blood loss in reported cases (median units red blood cells transfused, 0 vs 7, p = 0.003). Two of the three cases of placenta percreta at our institution were identified ante partum. The third case represents the first reported with antepartum identification of percreta followed by deliberate conservative treatment. CONCLUSIONS: With greater involvement of surrounding tissues, conservative treatment was preferred in hemodynamically stable patients. If surgical excision of the placenta is attempted or necessary, physicians experienced in pelvic dissection must be involved because of the frequency of maternal morbidity and mortality.

Adult↗

PubMed1995

A comparison of conservative therapy and early selective ligation in the treatment of lymphatic complications following vascular procedures.

BACKGROUND: Lymphatic leakage is a relatively uncommon but serious complication following vascular procedures. A conservative approach consisting of bed rest, leg elevation, prophylactic antibiotics, compressive dressings, and intermittent aspiration is the most commonly used treatment. Because of the long time it takes to cure this condition and the potential for infections, a more aggressive approach consisting of wound exploration and ligation of the leaking lymphatic has been proposed. We review our experience of the past 3 years treating 17 of these complications by using 1 of these 2 approaches. PATIENTS AND METHODS: Seventeen groin complications were seen over a period of 3 years. Ten (59%) patients were treated by selective ligation assisted with isosulfan blue dye injection, and the remaining 7 (41%) were treated conservatively. RESULTS: Mean hospital stay was 2.4 days (range 1 to 4) for the operative group versus 19 days (range 14 to 42) for the conservative group. One complication was seen in the operative group, whereas 4 (57%) patients developed groin infections following conservative therapy. One (10%) patient developed a recurrence following ligation that was treated successfully by reoperation. CONCLUSION: Our experience with the use of surgical ligation of leaking lymphatic assisted by isosulfan blue, when compared with conservative treatment, has led to a decrease in hospital stay, lower complication rates, and fewer recurrences. In our view, this approach represents the best form of treatment for postoperative groin lymphatic complications.

Adult↗