Lymphatic mapping and ligation for persistent ascites after surgery for gynecologic malignancy

BACKGROUND:: Ascites after lymphatic dissection, usually amenable to conservative management, may require surgery. We describe a technique in the context of treatment for gynecologic malignancy to localize and ligate lymphatic leaks. CASE:: The patient was a 37-year-old woman with recurrent ovarian carcinoma, who developed recurrent chylous and lymphatic ascites after secondary cytoreduction surgery including lymph node resection in multiple basins. Ascites were refractory despite paracenteses, dietary modification, and octreotide therapy. Sclerotherapy was unsuccessful. Surgical ligation of the lymphatic leak was accomplished with injection of isosulfan blue dye into groin nodes to assist with localization. CONCLUSION:: Select cases of persistent ascites after surgery for gynecologic malignancy will require surgery after conservative measures are attempted. Awareness of options for management is important for those caring for women with gynecologic cancer.