Management of lymphoceles after renal transplantation: laparoscopic versus open drainage.

Abstract

PURPOSE:

Laparoscopic surgery has become widely accepted for the treatment of lymphoceles following kidney transplantation. In this single center study we retrospectively reviewed our results of the surgical management of post-transplant lymphoceles, assessing indication and outcome of laparoscopic versus open drainage.

MATERIALS AND METHODS:

The records of 60 patients who underwent surgical treatment for a symptomatic lymphocele following kidney transplantation or combined kidney/pancreas transplantation were retrospectively reviewed.

RESULTS:

Between 1995 and 2002, 1,836 patients received a kidney transplant at the University of California San Francisco. In 60 patients (3.3%) a symptomatic lymphocele developed and either laparoscopic (20) or open drainage (40) was completed. The conversion rate from laparoscopic to open drainage was 16.5%. The most common indications for open lymphocele drainage were noninfectious wound complications (13 patients) and a high risk of vessel or ureter injury (8) due to proximity of the lymphocele to hilar structures. Additional surgery on the graft was required in 5 patients. Intraoperative blood loss was significantly lower in the laparoscopy group. Median hospital stay was 1 day in the laparoscopy group versus 4 days in the open drainage group. No perioperative complications were observed in either group. After a median followup of 38 months, 2 patients in each treatment group had a symptomatic recurrence.

CONCLUSIONS:

Although both surgical approaches are safe and effective, laparoscopic drainage should remain the method of choice for the treatment of post-transplant lymphocele. However, open drainage should be performed in patients with wound complications and in those with a small lymphocele adjacent to vital renal structures.

• Authors: T Florian Fuller, Sang-Mo Kang, Ryutaro Hirose, Sandy Feng, Peter G Stock, Chris E Freise
• Journal: The Journal of urology (J Urol) Vol. 169 Issue 6 Pg. 2022-5 (Jun 2003) ISSN: 0022-5347 [Print] United States
• PMID: 12771709 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Blood Loss, Surgical
• Drainage (methods)
• Female
• Humans
• Kidney Transplantation (adverse effects)
• Laparoscopy
• Lymphocele (etiology, surgery)
• Male
• Retrospective Studies