The optimal treatment of lymphoceles following renal transplantation

Abstract

Lymphoceles are well-recognized complications following kidney transplantation. The authors describe their experience with the treatment of eight clinically significant lymphoceles (incidence 2.7%). In seven patients percutaneous needle aspiration was attempted, often repeatedly, both for diagnostic and therapeutic purposes. In all of the patients the lymphocele recurred within days and internal marsupialization was therefore performed, in the last two patients utilizing minimal access surgery through laparoscopy. There were no postoperative complications or signs of a recurrence of the lymphocele. Patients following the laparoscopic marsupialization had a much briefer hospital stay and postoperative convalescence. Our results confirm that internal marsupialization is the procedure of choice for most post-transplant lymphoceles. Internal marsupialization through laparoscopy should be used in patients who meet the standard criteria for laparoscopy.

Laparoscopic fenestration of posttransplant lymphoceles

“…The incidence of lymphoceles following renal transplantation has been reported to be less than 1% up to 20%, whereas only about 5% become symptomatic (Table 1). Lymphoceles usually develop within 3 months after renal transplantation, with a range from 1 week up to several years [15,39].…”

“…Posttransplant lymphoceles have been reported in less than 1% to as many as 20% of these patients, but only 5.5% are symptomatic (Table 1) [1, 15, 23, 25, 26, 28, 32±34, 39, 40]. Lymph vessel traumatization at the operating site or in the donor organ, acute rejection episodes, and certain drugs such as heparin, steroids, and diuretics are believed to be the most common causes of posttransplant lymphoceles [1,13,23,26,39,45]. Patient who have had multiple renal transplantations are also at higher risk for the development of a lymphocele [15,40].…”

Laparoscopic treatment of lymphocele after kidney transplantation

“…The recurrence rate after this procedure is acceptably low (7-20%) [13,20], but the procedure has its drawbacks (i.e., laparotomy with prolonged ileus, changes in immunosuppressive therapy ad- [20] 1988 10 0 0 0 Langle et al [13] 1990 18 0 1 (5) 2 (11) Shaver et al [24] 1993 6 0 0 0 Gill et al [7] 1995 26 2 (8) 1 (4) 7 (26) Gruessner et al [9] 1995 23 0 0 5 (21) Melvin et al [17] 1997 8 0 0 0 Bischoff et al [2] 1998 20 0 0 2 (10) Total 129 3 (2.3) 2 (1.6) 19 (15) a Iatrogenic urinary tract lesion excluded Hence the popularity of laparoscopic treatment, which has been proposed as the method of choice for posttransplantation lymphocele. However, there are no randomized clinical trials as yet to support this recommendation, and most of the evidence for the superiority of the laparoscopic approach is based only on comparison between open-surgery series and laparoscopic series.…”

Laparoscopic treatment of lymphoceles following kidney transplantation by intraperitoneal fenestration and omentoplasty

“…It is therefore logical to consider any other technique making internal drainage possible with minimal surgical morbidity as the future method of choice. The advent of diagnostic and therapeutic endoscopic surgery, its expanding use in abdominal and thoracic surgical pathologies, and the safety of its performance have led to its use in the surgical treatment of lymphoceles after kidney transplantation [1,12,17].…”

“…The method allows internal drainage Correspondence to: J. P. Squifflet of the collection by intraperitoneal fenestration, completed by an omentoplasty [1,3,12,17].…”