Laparoscopic management of giant abdominal cystic lymphangiomas: experience from the queen Fabiola children’s university hospital

Cystic lymphangioma is a benign malformities tumor of the lymphatic system. Its abdominal location is much rarer. We reviewed the cases of giant abdominal cystic lymphangioma managed laparoscopically. We used a video-assisted needle aspiration technique in our Pediatric Surgery Department of the Queen Fabiola Children’s University Hospital (HUDERF) in Brussels. From this study, we analyzed the clinical findings and surgical outcomes. We conducted a retrospective study in the Pediatric Surgery Department of HUDERF, Brussels. The study period was from January 1, 2014, to January 1, 2024. All patients (5) with a confirmed diagnosis of giant cystic lymphangiomas and who underwent laparoscopic surgery were included. Those who had been operated on by open surgery were excluded and those who had cyst lengths less than 5 cm (5). The laparoscopic management involved aspirating the cyst with a needle via a laparoscopic approach, followed by cyst resection either laparoscopically or through a video-assisted approach. Parameters that were studied include: age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, localization, size of cyst, type of mass, surgical technique and duration, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. We retrieved ten files of patients presenting with abdominal cystic lymphangioma. Two patients underwent exclusive open surgery and 3 patients with cystic lymphangiomas less than 5 cm in length were excluded. The mean age of the patients was 6 years with extremes ranging from 4 to 11 years. Male patients were predominant (3/5). The mean weight was 27.4 kg with extremes ranging from 17 to 55 kg. The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 5 cases. Abdominal ultrasound was performed on all patients. Magnetic resonance imaging (MRI) was done in 3 patients, and Abdominal computed tomography (CT) was performed in 1 patient. The mass was multiloculated in 5 cases. Treatment consisted of pure laparoscopic resection of the cyst in 2 cases, and laparoscopic-assisted resection in 3 cases (with extra-peritoneal small bowel resection and mesenteric detorsion in 1 case). After a follow-up period of 5 years, the patients had a simple clinical course, and no recurrence was observed in our series. Giant abdominal cystic lymphangiomas can be managed laparoscopically using the video-assisted needle aspiration technique. This technique is highly effective and minimally invasive, regardless of cyst size.