Mesenteric and omental lymphatic malformations in children: seven-year surgical experience from two centers in China

doi:10.21203/rs.3.rs-3135949/v1

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Mesenteric and omental lymphatic malformations in children: seven-year surgical experience from two centers in China

https://doi.org/10.21203/rs.3.rs-3135949/v1

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Purpose To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in children.

Methods This retrospective study included 148 ML patients and 53 OL patients who underwent surgical treatment at two centers between January 2016 and December 2022. Details of the patients’ clinical characteristics, cyst characteristics, preoperative complications, surgical methods, and prognosis were retrieved and compared.

Results No significant differences between ML and OL patients were noted in sex ratio, prenatal diagnosis, and age of diagnosis. The presence of vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002), but OL patients were more likely to be misdiagnosed (35.8% vs. 18.8%, P = 0.012). The size of cysts in OL patients was significantly larger than that in ML patients (14.0 [8.0, 17.3] vs. 10.0 [6.0, 13.0] cm, P＜0.001), and cysts with turbid fluid were more common in OL patients (38.0% vs. 20.6%, P＜0.001). Cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients, and the incidence of postoperative complications was lower (12.6% vs. 4.2%, P = 0.165) among the latter. The main postoperative complications included adhesive ileus and recurrence of cysts. Additionally, laparoscopic surgery was more commonly undergone among OL patients (69.8% vs. 39.2%, P＜0.001).

Conclusions Compared with ML patients, OL patients are more prone to misdiagnosis and infection, but the prognosis of surgical treatment is better. Laparoscopic cyst excision may be the preferred treatment for OL patients.

Children

Mesenteric lymphatic malformation

Omental lymphatic malformation

Surgical treatment

Abdominal lymphatic malformations are rare but relatively common in the mesentery and omentum.
Surgical treatment is still the mainstream treatment for abdominal lymphatic malformations to relieve obvious symptoms and locate the lymphatic malformations.

What is New:

Compared with mesenteric lymphatic malformations, omental lymphatic malformations are more prone to misdiagnosis and infection.
Laparoscopic cyst excision can be the preferred surgical treatment for omental lymphatic malformations.

Abdominal lymphatic malformations are rare, accounting for only 5% of lymphatic malformations, but relatively common in the mesentery and omentum [1–3]. The reported incidence of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) is approximately 1/250,000–1/20,000 [3–5]. Considering that cysts in ML are often inseparable from the mesentery and intestinal wall, surgical treatment may include ML excision with segmental bowel resection, so a multidisciplinary approach, including medications, sclerotherapy and surgical treatment, is increasingly recommended for ML to achieve a better result [6–8]. In contrast, the cysts in OL are less likely to adhere to neighbouring viscera and are mainly in the greater omentum [9, 10]. The recommended treatment for OL is complete surgical resection. The initial symptoms of ML and OL patients are usually vague and almost similar, but symptoms can be aggravated when the size of a cyst increases or complications occur [11, 12]. In addition, apart from the absence of intermixing between the fluid and loops of the bowel being a possible clue to the presence of OL, preoperative imaging examinations can hardly distinguish OL from ML [13]. Therefore, surgery is still the mainstream treatment for abdominal lymphatic malformations to relieve obvious symptoms and locate the lymphatic malformations.

Laparoscopic surgery, including robotic-assisted and laparoscopic-assisted surgery, has become an option for treating ML and OL, but previous reports are sparse with small sample sizes [14–16]. Therefore, this retrospective study reported the surgical experience, including open surgery and laparoscopic surgery, from two tertiary university hospitals in China to compare the clinical characteristics, surgical management and prognosis of ML and OL in children.

Patients

After being approved by the Ethics Committee of Beijing Children’s Hospital (Approval number: [2023]-E-088-R), we conducted a retrospective, observational, multicenter study of ML and OL patients treated at Beijing Children’s Hospital, Children’s National Medical Center, China, and Shengjing Hospital of China Medical University, from January 2016 to December 2022. Eligible participants were identified by reviewing their electronic medical records, and all patients included in this study underwent the surgical treatment and were confirmed with ML or OL by postoperative histopathology.

Study design

Clinical data of patients that needed to be collected were discussed and assigned before the study. Jiayu Yan and Shuting Liu collected clinical data from their hospitals, including inpatient, outpatient, and follow-up data. The inpatient data included clinical characteristics (sex, prenatal diagnosis, age of diagnosis, presenting symptoms, misdiagnosis before admission, laboratory examinations, and preoperative imaging examinations), preoperative complications, surgical details, and pathological data. According to previous studies, the preoperative complications of ML and OL mainly included hemorrhage, infection and rupture of the cyst, and intestinal or omental volvulus caused by the cyst [6]. However, hemorrhage and infection of cyst are often concomitant and challenging to distinguish [11].

The surgical details and pathological data were extracted from surgical records and postoperative pathological results to summarize the cyst characteristics and surgical methods. The cyst characteristics included the specific location, classification, pathological type, cyst size, and cyst content. The specific locations of ML varied depending on the mesentery involved, including intestinal ML, colonic ML and combined ML, and the specific locations of OL varied depending on the omentum involved, including greater ML and lesser ML [6]. Considering that the previously reported classifications of ML could not be applied to OL, the simple classification of OL reported was used in this study, including Group 1 (patients with clinical features due to the size of the cyst), Group 2 (patients with clinical features due to the preoperative complications of the cyst), and Group 3 (patients without clinical features but incidentally detected) [4, 6, 17]. According to the number and size of cysts contained, the pathological types included macrocystic-type (single or multilocular, ≥ 1 cm), microcystic-type (single or multilocular, < 1 cm) and mixed cystic-type (multilocular) [18, 19]. The size of the cysts referred to the length of the entire cyst obtained from surgical records for patients undergoing open surgery and from preoperative imaging findings for patients undergoing laparoscopic surgery. The cysts of ML and OL could contain serous, chylous, or turbid fluid, including serosanguinous fluid caused by hemorrhage or infection of the cyst [6, 11]. According to the surgical approach, surgical methods could be divided into open surgery (including laparoscopic conversion to open surgery) and laparoscopic surgery (including laparoscopic-assisted surgery and robot-assisted surgery).

The outpatient data mainly included postoperative ultrasound results, and telephone follow-up interviews were completed for all patients before June 2023. The postoperative complications mainly had recurrence (including residual cysts) and adhesive ileus based on the postoperative hospitalization data, postoperative ultrasound results, and telephone interviews.

For analysis, we compared the clinical characteristics of ML and OL in children and analyzed the prognosis of various surgical methods. In addition, we also tried to find the factors influencing the choice of open surgery or laparoscopic surgery for ML and OL patients.

Statistical Analysis

Continuous variables with a normal distribution are presented as the means ± standard deviations and were analyzed with Student’s t test. Continuous variables with a nonnormal distribution are presented as the median (interquartile range) and were analyzed with the Mann-Whitney test. Categorical variables are expressed as numbers (percentages) and were analyzed with the χ2 test or Fisher’s exact test. Multivariate analysis was performed with binary logistic regression. P < 0.05 (2-sided) was considered statistically significant.

Patient characteristics

A total of 148 ML patients and 53 OL patients were enrolled in this study from the two centers during the study period (Fig. 1). According to the surgical records, 104 ML (104/148, 70.3%) were located at the intestinal mesentery, 39 (39/148, 26.3%) ML were in the mesocolon, and 5 (5/148, 3.4%) ML involved both the intestinal mesentery and mesocolon. Of the OL patients, 48 (48/53, 90.6%) OL were in the greater omentum, and 5 (5/53, 94%) OL were in the lesser omentum.

Table 1 documents the clinical characteristics of ML and OL patients. No significant differences between ML and OL patients were noted in sex ratio, prenatal diagnosis, and age of diagnosis. Peritoneal effusion or abdominal cystic mass was found in 8 patients (8/201, 3.9%) with gestational ages from 26 to 39 weeks by prenatal ultrasound. The median age of diagnosis in ML and OL patients was 3.8 [2.3, 5.7] years and 3.8 [2.8, 5.9] years, respectively, and nearly half of ML (72/148, 48.6%) and OL (27/53, 50.9%) patients were aged 3–7 years at diagnosis (Fig. 2). Abdominal pain was the predominant clinical symptom in both ML and OL patients (70.9% vs. 60.4%, P = 0.156), but the presence of vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002). OL patients were more likely to be misdiagnosed than ML patients (35.8% vs. 18.8%, P = 0.012). Gastroenteritis (10 cases in ML patients and 5 in OL patients) and peritoneal effusion (3 cases in ML patients and 4 in OL patients) were the main causes of suspicion before the definite diagnosis. In addition, the laboratory results at admission showed that OL patients had a higher percentage of infection (45.3% vs. 29.7%, P = 0.040). Abdominal ultrasound (95.3% vs. 96.2%, P＞0.999) and CT (81.1% vs. 77.1%, P = 0.560) were the most common preoperative imaging examinations in both ML and OL patients (Fig. 3).

Table 1

Clinical characteristics of patients with ML and OL
Characteristics	ML (n = 148)	OL (n = 53)	P value
Sex, n (%) Male Female	90 (60.8) 58 (39.2)	28 (52.8) 25 (47.2)	0.311
Prenatal diagnosis, n (%)	5 (3.4)	3 (5.7)	0.437
Age (years)	3.8 [2.3, 5.7]	3.8 [2.8, 5.9]	0.598
Symptoms, n (%) Incidental diagnosis Abdominal pain Vomiting Abdominal distention Abdominal mass Fever Diarrhea	9 (6.1) 105 (70.9) 69 (46.6) 50 (33.8) 32 (21.6) 35 (23.6) 14 (9.5)	7 (13.2) 32 (60.4) 12 (22.6) 11 (20.8) 7 (13.2) 15 (28.3) 3 (5.7)	0.100 0.156 0.002 0.077 0.184 0.501 0.567
Misdiagnosis before admission, n (%)	28 (18.9)	19 (35.8)	0.012
Laboratory examination, n (%) Normal Infection^*	104 (70.3) 44 (29.7)	29 (54.7) 24 (45.3)	0.040
Imaging examinations, n (%) Ultrasound CT MRI	141 (95.3) 120 (81.1) 6 (4.1)	51 (96.2) 41 (77.4) 1 (1.9)	＞0.999 0.560 0.678
^*The laboratory data collected included C-reactive protein, white blood cells, and hemoglobin. The patients with C-reactive protein > 8 mg/L or white blood cells > 10 × 10⁹/L were considered infected.
ML Mesenteric lymphatic malformations, OL Omental lymphatic malformations

Cyst characteristics and preoperative complications

Regarding the cyst characteristics, there were significant differences between ML and OL patients in the cysts’ pathological types, sizes and contents (Table 2). The macrocystic-type cyst was more common in OL patients (94.3% vs. 78.4%, P = 0.047). The size of cysts in OL patients was significantly larger than that in ML patients (14.0 [8.0, 17.3] vs. 10.0 [6.0, 13.0] cm, P＜0.001). In addition, cysts with chylous fluid and turbid fluid were more frequent in ML patients (33.1% vs. 4.0%, P＜0.001) and OL patients (38.0% vs. 20.6%, P＜0.001), respectively. However, there was no significant difference in classifications between ML and OL patients.

Table 2

Comparison of cyst characteristics and preoperative complications between patients with ML and OL
Variable	ML (n = 148)	OL (n = 53)	P value
Classifications, n (%)^* Group 1 Group 2 Group 3	70 (47.3) 69 (46.6) 9 (6.1)	25 (47.2) 21 (39.6) 7 (13.2)	0.233
Pathological types, n (%) Macrocystic-type Microcystic-type Mixed cystic-type	116 (78.4) 8 (5.4) 24 (16.2)	50 (94.3) 3 (5.7) 0 (0.0)	0.047
Cyst size (cm)	10.0 [6.0, 13.0]	14.0 [8.0, 17.3]	＜0.001
Cyst contents, n (%) Serous Chylous Turbid	136 (12 unacquirable) 63 (46.3) 45 (33.1) 28 (20.6)	50 (3 unacquirable) 29 (58.0) 2 (4.0) 19 (38.0)	＜0.001
Preoperative complications, n (%) Hemorrhage or infection Volvulus^** Rupture	47 (31.8) 29 (19.6) 2 (1.4)	22 (41.5) 3 (5.7) 2 (3.8)	0.016 0.199 0.284
^*Group 1: patients with clinical features due to the size of the cyst, Group 2: patients with clinical features due to the preoperative complications of the cyst, Group 3: patients without clinical features but incidentally detected
^**Volvulus referred to intestinal volvulus in patients with ML and omental volvulus in patients with OL
ML Mesenteric lymphatic malformations, OL Omental lymphatic malformations

Hemorrhage or infection was the predominant preoperative complication in both ML and OL patients, but the incidence differed significantly. More OL patients had preoperative hemorrhage or infection of cyst than ML patients (41.5% vs. 31.8%, P＜0.016).

Surgical methods and outcomes

Regarding the specific surgical methods, 48 (48/148, 32.4%), 89 (89/148, 60.1%), 10 (10/148, 6.8%) and 1 (1/148, 0.7%) ML patients underwent ML excision, ML excision with segmental bowel resection, partial ML excision and drainage, and partial ML excision with segmental bowel resection and drainage, respectively (Fig. 4). Of the OL patients, 51 (51/51, 96.2%) and 2 (2/53, 3.8%) underwent OL excision and partial OL excision, respectively. In total, complete cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients. Of these patients, up to our follow-up, the incidence of postoperative complications in OL patients was lower (4.2% vs. 12.6%, P = 0.165). Recurrence of cysts (11/196, 5.6%) and adhesive ileus (10/196, 5.1%) were the main postoperative complications in all 196 children followed (146 ML and 50 OL).

As shown in Table 3 and Table 4, more OL patients underwent laparoscopic surgery (69.8% vs. 39.2%, P＜0.001) than ML patients. Among ML patients, those who underwent laparoscopic surgery had a smaller average size of cysts (8.0 [5.0, 10.3] vs. 10.0 [7.0, 16.0] cm, P = 0.001) and a higher proportion of cysts with serous fluid (61.5% vs. 36.9%, P = 0.014). Further multivariable analysis showed that cysts with a smaller size might be an influencing factor in choosing laparoscopic surgery in ML patients (OR, 1.1; 95% CI, 1.0-1.2; P = 0.004). However, no factors that might influence the choice of laparoscopic surgery were found in OL patients.

Table 3

Factors influencing the choice of laparoscopic or open surgery for ML
Characteristics	Open surgery (n = 90)	laparoscopic surgery (n = 58)	P value	Logistic regression, P value	OR, 95% CI
Sex, n (%) Male Female	56 (62.2) 34 (37.8)	34 (58.6) 24 (41.4)	0.661	——	——
Age, years, n (%)	3.6 [2.1, 6.0]	4.0 [2.9, 5.5]	0.376	——	——
≤ 3 3–7 ＞7	36 (40.0) 39 (43.3) 15 (16.7)	16 (27.6) 33 (56.9) 9 (15.5)	0.233	——	——
Symptoms, n (%) Incidental diagnosis Abdominal pain Vomiting Abdominal distention Abdominal mass Fever Diarrhea	5 (5.6) 66 (73.3) 39 (43.3) 35 (38.9) 18 (20.0) 23 (25.6) 8 (8.9)	4 (6.9) 39 (67.2) 30 (51.7) 15 (25.9) 14 (24.1) 12 (20.7) 6 (10.3)	0.738 0.426 0.318 0.102 0.551 0.496 0.768	—— —— —— —— —— —— ——	—— —— —— —— —— —— ——
Cyst size, cm, n (%)	10.0 [7.0, 15.0] 86 (4 unacquirable)	8.0 [5.0, 10.3] 57 (1 unacquirable)	0.001	0.006	1.1 (1.0-1.2)
≤ 5 5–10 ＞10	13 (15.1) 41 (47.7) 32 (37.2)	17 (29.8) 27 (47.4) 13 (22.8)	0.055	——	——
Location, n (%) Small intestine Colon Combined	63 (70.0) 24 (26.7) 3 (3.3)	41 (70.7) 15 (25.9) 2 (3.4)	0.994	——	——
Cyst contents, n (%) Serous Chylous Turbid	84 (6 unacquirable) 31 (36.9) 31 (36.9) 22 (26.2)	52 (6 unacquirable) 32 (61.5) 14 (26.9) 6 (11.5)	0.014	0.070	——
Preoperative complications, n (%) Hemorrhage or infection Volvulus Rupture	29 (32.2) 20 (22.2) 1 (0.9)	18 (31.0) 9 (15.5) 1 (1.9)	0.880 0.316 ＞0.999	—— —— ——	——
ML Mesenteric lymphatic malformations

Table 4

Factors influencing the choice of laparoscopic or open surgery for OL
Characteristics	Open surgery (n = 16)	laparoscopic surgery (n = 37)	P value
Sex, n (%) Male Female	10 (62.5) 6 (37.5)	18 (48.6) 19 (51.4)	0.354
Age, years, n (%)	3.4 [2.3, 5.1]	4.5 [2.9, 6.3]	0.146
≤ 3 3–7 ＞7	6 (37.5) 8 (50.0) 2 (12.5)	11 (29.7) 19 (51.4) 7 (18.9)	0.785
Symptoms, n (%) Incidental diagnosis Abdominal pain Vomiting Abdominal distention Abdominal mass Fever Diarrhea	3 (18.8) 10 (62.5) 4 (25.0) 3 (18.8) 3 (18.8) 4 (25.0) 0 (0.0)	4 (10.8) 22 (59.5) 8 (21.6) 8 (21.6) 4 (10.8) 11 (29.7) 3 (8.1)	0.419 0.835 ＞0.999 ＞0.999 0.419 ＞0.999 0.545
Cyst size, cm, n (%)	15.0 [12.0, 20.0] 15 (1 unacquirable)	11.0 [8.0, 16.0] 35 (2 unacquirable)	0.081
≤ 5 5–10 ＞10	1 (6.7) 2 (13.3) 12 (80.0)	6 (17.1) 11 (31.4) 18 (51.4)	0.149
Location, n (%) Greater omentum Lesser omentum	14 (87.5) 2 (12.5)	34 (91.9) 3 (8.1)	0.632
Cyst contents, n (%) Serous Chylous Turbid	16 9 (56.3) 1 (6.3) 6 (37.5)	34 (3 unacquirable) 20 (58.8) 1 (2.9) 13 (38.2)	0.864
Preoperative complications, n (%) Hemorrhage or infection Volvulus Rupture	8 (50.0) 2 (12.5) 0 (0.0)	14 (37.8) 1 (2.7) 2 (5.4)	0.409 0.213 ＞0.999
OL Omental lymphatic malformations

In the present study, we first systematically compared the clinical characteristics and prognosis of ML and OL with the largest sample sizes from two centers and found that OL patients were more prone to misdiagnosis and infection before the definite diagnosis. Correspondingly, compared with ML patients, the size of cysts in OL patients was significantly larger, and cysts with turbid fluid were more frequent in OL patients. In addition, our findings demonstrated that laparoscopic surgery could be the preferred surgical treatment for OL patients with a good prognosis.

A total of 148 ML patients and 53 OL patients were evaluated, both groups exhibiting a predominance of males, similar to previous studies [3–5]. Although with the development of prenatal ultrasound, it was possible to indicate excessive peritoneal effusion or abdominal cystic masses in the fetus during pregnancy, it seemed impossible to distinguish ML from OL [20, 21]. Before the cysts developed complications, most ML and OL patients were asymptomatic or had mild symptoms and only received conservative treatments without imaging examinations. Their conditions were often misdiagnosed, sometimes as gastroenteritis [4]. In addition, even after the occurrence of complications, the symptoms of both diseases are various, nonspecific and difficult to diagnose and distinguish [5]. As observed in our study, except for vomiting, the presenting symptoms did not differ significantly between ML and OL patients. The presence of vomiting often indicates bowel obstruction, which might be related to the compression of the intestine by the enlarging cyst or the occurrence of intestinal volvulus [22, 23]. Our previous studies have confirmed a high rate of intestinal volvulus in ML patients [6, 11]. Compared with OL patients, ML patients might have more urgent symptoms, so it is recommended that the imaging examinations be performed as soon as possible. Consequently, ML patients in our study had a lower misdiagnosis rate.

Interestingly, we noted that the laboratory results showed that OL patients had a higher percentage of infection. There are two possible reasons for this phenomenon. First, as observed in our study, more OL patients had hemorrhage of cyst at admission, and hemorrhage could activate the body’s immune system, leading to the mild elevation of inflammatory markers, such as C-reactive protein [24, 25]. Second, cysts with severe hemorrhage might be more susceptible to infection. In adult intracerebral hemorrhage, the size of the hematoma was a predictor of infection development [26]. In ML patients, the size of the cyst has been shown to identify the presence of preoperative hemorrhage or infection. Our results also showed that OL patients had significantly larger cysts than ML patients, and cysts with turbid fluid occurred more frequently in OL patients. However, it was difficult to accurately distinguish between hemorrhage and infection from the cysts’ appearance, so the infection process after hemorrhage could not be further analyzed. In addition, in our study, the presence of C-reactive protein at > 8 mg/L or white blood cells at > 10 × 10⁹/L indicated an infection, possibly leading to some bias in the results.

Previous studies have shown that complete surgical resection is an effective and durable treatment for abdominal lymphatic malformations with a good prognosis [2, 27, 28]. However, for some complex abdominal lymphatic malformations that had multicentric and diffusely infiltrated lymphatic malformations involving important organs, such as type III and type IV ML reported by Kim SH et al., complete surgical resection is very difficult with a high recurrence rate, so medications and sclerotherapy could be the first choice of treatment. However, the long-term prognosis still needs further study [6, 28]. For OL patients, the recommended treatment is complete surgical resection. Since it is challenging to distinguish ML and OL through preoperative imaging examinations, surgery is necessary for patients suspected of the above two diseases [2]. Our study revealed that OL patients had a better surgical prognosis than ML patients, especially those with complete OL excision, none of whom experienced the recurrence of cysts. This may be related to the high proportion (94.3%) of macrocystic-type cyst in OL patients. During the surgical treatment of OL patients with the macrocystic-type cyst, the omentum involved could be boldly removed to reduce recurrence. In the surgical treatment of ML, however, the surgeon should avoid more bowel resection whenever possible, and some small cysts in ML with microcystic-type or mixed cystic-type cyst cannot be identified by the naked eye [9, 28]. Therefore, ML patients are more likely to have a recurrence after surgical treatment.

The last point we have observed is that, compared with ML patients, more OL patients underwent laparoscopic surgery without any definite influencing factor. This would imply that, consistent with previous studies, almost all OL patients were eligible for laparoscopic surgery [10, 15, 29]. Previously reported laparoscopic surgery for abdominal lymphatic malformations included two surgical approaches. One was complete laparoscopic surgery, which is widely used in adult patients with a large abdominal cavity, and the other was laparoscopic-assisted exploration to locate and decompress the cyst of lymphatic malformations first, followed by cyst excision through a slightly expanded umbilical incision, which is more commonly used in pediatric patients [16, 30–32]. The cysts with large size in pediatric patients could impair surgical visualization during laparoscopic surgery. Therefore, according to our study, in the surgical treatment of OL, the experience of the surgeon might be the main factor influencing the specific surgical approaches.

There are some significant limitations to the interpretation of our results. First, due to the retrospective nature of our study, the cyst characteristics of each patient cannot be guaranteed to be entirely correct, as they are summarized from surgical records by two surgeons rather than intraoperative photographs. Although a unified database was designed using Excel software before data collection, this still could induce some bias. In addition, our study did not further analyze surgical options and prognosis of ML and OL among different surgeons, which might be the main factor influencing the surgical methods. Furthermore, due to the lack of complete original images from the two centers, the imaging results of ML and OL in our study were not evaluated for preoperative distinguish, which was the focus of our future research.

ML: mesenteric lymphatic malformations

OL: omental lymphatic malformations

Authors’ contributions JY and YC conception and design of the work. JY and SL conducted data collection. JY and YF performed data analysis. JY, YF and LS contributed to data interpretation. JY, YF, YB and YC assisted in drafting the manuscript. All authors critically revised the manuscript and read and approved the final manuscript for submission.

Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability Not applicable.

Code availability Not applicable.

Ethics approval The study received approval by the Ethics Committee of Beijing Children’s Hospital (Approval number: 2023-E-088-R) and conducted according to the Helsinki principles.

Consent to participate N/A.

Consent for publication N/A.

Competing interests The authors have no relevant financial or non-financial interests to disclose.

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Mesenteric and omental lymphatic malformations in children: seven-year surgical experience from two centers in China

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Abstract

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What is Known

Introduction

Materials and methods

Patients

Study design

Statistical Analysis

Results

Patient characteristics

Cyst characteristics and preoperative complications

Surgical methods and outcomes

Discussion

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