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Serirodom M, Taweemonkongsap T, Chotikawanich E, Jitpraphai S, Woranisarakul V, Shrestha S, Hansomwong T. Lymphocele in Kidney Transplantation: A Comparison of Ligation and Non-ligation Technique of Iliac Lymphatic Dissection. Transplant Proc 2022; 54:2197-2204. [PMID: 36163083 DOI: 10.1016/j.transproceed.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/03/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To compare the incidence of lymphocele in kidney recipients following 2 lymphatic vessel division techniques: ligation and non-ligation. METHODS Retrospective reviews of the records of 402 patients with end-stage renal disease who underwent kidney transplantation from April 2015 to December 2019 at Siriraj Hospital. RESULTS Four hundred two patients were included in the study: 54.9% of the patients were male, and the patient's mean age was 41 years. There were 25.1% and 74.9% that received kidney grafts from living and deceased donors, respectively. The preoperative renal replacement therapies were 83.3% hemodialysis, 12.9% peritoneal dialysis, and 3.7% preemptive transplantation. Two hundred forty-nine patients received lymphatic division with the ligation technique and 153 patients received the non-ligation. Lymphoceles were found in 31 cases (7.7%). Lymphocele occurrence in the ligation group was lower than in the non-ligation group: 5.2% compared to 11.8% (P value = .017). There were 22.6% of lymphoceles that had a spontaneous resolution with no treatment. DISCUSSION The ligation of iliac lymphatic vessels during division reduced the incidence of lymphoceles non-ligation.
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Affiliation(s)
- M Serirodom
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Shrestha
- Department of Surgery, Pokhara Academy of Health Sciences, Nepal
| | - T Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Bakkaloglu H, Bayraktar A, Bulakci M, Aydin AE. Intraperitoneal Ultrasound-Guided Safe Laparoscopic Fenestration of Lymphocele After Kidney Transplantation. J Laparoendosc Adv Surg Tech A 2021; 32:299-303. [PMID: 33826425 DOI: 10.1089/lap.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Lymphocele is a common complication after kidney transplantation, which does not require treatment unless it is symptomatic. In this study, we aimed to evaluate the incidence, clinical symptoms, treatment choices, and success of different treatment methods of symptomatic lymphocele. Materials and Methods: We evaluated 168 patients who had kidney transplantation between January 2012 and January 2020. Patients with decreased kidney functions due to lymphocele formation during the clinical follow-up were included in the study. External drainage catheter was placed in all patients, except one. In case of treatment failure with external drainage, laparoscopic fenestration guided by intraperitoneal ultrasonography was performed. Clinical symptoms and success rates of treatments were evaluated. Results: Symptomatic lymphocele requiring interventional treatment was detected in 15 (8.9%) of 168 renal transplant patients. All of the symptomatic lymphocele cases had increased serum creatinine levels, whereas 10 had decreased urine volume, 4 had abdominal discomfort, and 2 had ipsilateral lower extremity edema. External drainage catheter was placed as the first-line treatment in 13 patients. In 6 cases, due to treatment failure with external drainage and in 2 patients as a first-choice treatment, laparoscopic fenestration was performed. No lymphocele recurrence was observed during follow-up. Conclusion: Among various methods defined in the treatment of lymphocele, use of laparoscopic fenestration is increasing because of its high success rate and advantages over other methods. Intraperitoneal ultrasound-guided laparoscopic fenestration is a useful and safe method that can be performed as a first-choice treatment since it eliminates the risk of organ injury or bleeding.
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Affiliation(s)
- Huseyin Bakkaloglu
- Department of General Surgery and Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adem Bayraktar
- Department of General Surgery and Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mesut Bulakci
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emin Aydin
- Department of General Surgery and Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Predictors of symptomatic lymphocele after kidney transplantation. Int Urol Nephrol 2019; 51:2161-2167. [PMID: 31486950 PMCID: PMC6848241 DOI: 10.1007/s11255-019-02269-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022]
Abstract
Purpose The development of a symptomatic lymphocele (SL) is a frequent postoperative surgical complication after kidney transplantation. It may lead to pain and discomfort and cause transplant malfunction or even secondary graft loss. A large cohort of renal recipients was investigated to identify the possible risk factors for SL. Methods All renal transplant patients of a single centre were retrospectively analysed for SL between January 2010 and December 2017. The SL group was compared to a control group from the same cohort. Results 45 out of 1003 transplanted patients developed an SL (incidence 4.5%), on average 50 days after kidney transplantation. SLs developed more in older patients, in those with a PD catheter and in ADKDP as primary diagnosis. Surgical predictors for SLs were venous anastomosis on the external iliac vein, concomitant PD catheter removal, perfusion defects, shorter operating time, splint > 7 days, double J stenting, discharge with drain, low initial drain production and ureteral obstruction. Opening of the peritoneum, re-operation for postoperative bleeding and previous nephrectomy seem protective for developing SL. Conclusion We found multiple heterogeneous predictors for SL with a common denominator related to surgical management of the retroperitoneal space, peritoneum and the ureter. Future prospective studies are necessary to evaluate the influence of these variables on the development of SL.
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Jun H, Hwang SH. Diagnostic performance of multidetector computed tomography for symptomatic lymphoceles in kidney transplant recipients. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:30-35. [PMID: 35769147 PMCID: PMC9186869 DOI: 10.4285/jkstn.2019.33.2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Nerli R, Sushant D, Ghagane S, Nutalpati S, Mohan S, Dixit N, Neelagund S, Hiremath M. Lymphocele complications following renal transplantation. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_33_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ma X, Wang Y, Fan A, Dong M, Zhao X, Zhang X, Xue F. Risk factors, microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies. Arch Gynecol Obstet 2018; 298:1195-1203. [PMID: 30269216 PMCID: PMC6244691 DOI: 10.1007/s00404-018-4914-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
Objective To evaluate risk factors, microbiology and management of infected lymphocysts in patients undergoing systemic lymphadenectomy for gynecological cancer. Methods Patients with gynecological cancer who developed postoperative lymphocysts after lymphadenectomy were enrolled between January 2009 and June 2017. The clinical data of infected lymphocysts were analyzed and compared with non-infected lymphocysts. Multivariate analysis of risk factors, the microbiology and therapeutic strategies for infected lymphocysts were also evaluated. Results A total of 115 patients out of 619 developed postoperative lymphocysts, the incidence of infected lymphocysts was 4.36%. Infected lymphocysts were more frequently found in patients with combined pelvic and para aortic lymphadenectomy, higher number of resected pelvic lymph nodes, lower level of postoperative serum hemoglobin and higher proportion of neutropenia. The median diameter of infected lymphocysts was significantly larger than non-infected (71.89 vs 38.47 mm, P < 0.001) and a large size (diameter over 60 mm) was identified as an independent risk factor for infected lymphocysts (OR = 3.933, P = 0.017). The microbiology of infected lymphocysts includes gram-positive cocci, gram-negative bacillus and anaerobic bacteria. Percutaneous catheter drainage was successfully performed in 20 patients with infected lymphocysts. 16 of 19 patients with large lymphoceles received combined antibiobics and PCD therapy and showed clinical remission in all cases. Patients with large size infected lymphocysts who received combined therapy experienced a significantly shorter treatment period and lower recurrent rate than those with only antibiotics (P = 0.046, P = 0.018). Conclusions The current study demonstrated that a diameter over 60 mm was an independent risk factor for infected lymphocysts. The predominant bacteria originated from the urogenital or skin flora. The combination of PCD with appropriate antibiotics was a convenient and effective therapeutic strategy resulting in a high success rate.
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Affiliation(s)
- Xuegong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Mengting Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xin Zhao
- Department of Radiology, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xuhong Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China.
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Mihaljevic AL, Heger P, Abbasi Dezfouli S, Golriz M, Mehrabi A. Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: a systematic review. Transpl Int 2017; 30:543-555. [DOI: 10.1111/tri.12952] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/19/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery; University Hospital Heidelberg; Heidelberg Germany
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Prevention and management of lymphocele formation following kidney transplantation. Transplant Rev (Orlando) 2017; 31:100-105. [DOI: 10.1016/j.trre.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
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Jun H, Hwang SH, Lim S, Kim MG, Jung CW. Evaluation of postoperative lymphocele according to amounts and symptoms by using 3-dimensional CT volumetry in kidney transplant recipients. Ann Surg Treat Res 2016; 91:133-8. [PMID: 27617254 PMCID: PMC5016603 DOI: 10.4174/astr.2016.91.3.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/23/2016] [Accepted: 05/30/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. Methods We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. Results Among 92 recipients, the mean volume was 44.53 ± 176.43 cm3 and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm3 was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm3 were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm3, and serum creatinine level at one month were significant factors. Conclusion Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm3 or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Sungyoon Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 2015; 8:615-22. [PMID: 26413290 PMCID: PMC4581383 DOI: 10.1093/ckj/sfv064] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.
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Affiliation(s)
- Andrea Ranghino
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Giuseppe Paolo Segoloni
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Fedele Lasaponara
- Division of Urology , Città della Salute e della Scienza Hospital , Torino , Italy
| | - Luigi Biancone
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
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Stylianou K, Maragkaki E, Kokologiannakis G, Stratigis S, Vardaki E, Daphnis E. Refractory and massive lymphocele in a transplant patient with encapsulating peritoneal sclerosis treated with a single infusion of bleomycin: a case report. Transplant Proc 2013; 45:2831-3. [PMID: 24034060 DOI: 10.1016/j.transproceed.2013.02.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/02/2013] [Accepted: 02/16/2013] [Indexed: 10/26/2022]
Abstract
A 26-year-old Caucasian man developed a large lymphocele after living-related kidney transplantation necessitating repeated drainage of large volumes every other day owing to ureteral compression. An open laparotomy for internal drainage was unsuccessful because of severe encapsulating peritoneal sclerosis. Prolonged external drainage with a catheter was inefficient. Repeated fine-needle aspirations of large volumes were needed to maintain ureteral patency over a period of 4 months. Finally, a single instillation of bleomycin immediately and effectively treated the lympocele with no relapse over the following 5 years. The presence of encapsulating peritoneal sclerosis seemed to be an obstacle to surgical treatment.
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Affiliation(s)
- K Stylianou
- Nephrology Department, Heraklion University Hospital, Crete, Greece.
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Sim A, Ng LG, Cheng C. Occurrence of a lymphocele following renal transplantation. Singapore Med J 2013; 54:259-62. [DOI: 10.11622/smedj.2013104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ziętek Z, Iwan-Ziętek I, Sulikowski T, Sieńko J, Nowacki M, Zukowski M, Kaczmarczyk M, Ciechanowicz A, Ostrowski M, Rość D, Kamiński M. The outcomes of treatment and the etiology of lymphoceles with a focus on hemostasis in kidney recipients: a preliminary report. Transplant Proc 2012; 43:3008-12. [PMID: 21996212 DOI: 10.1016/j.transproceed.2011.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The etiopathogenesis of lymphoceles remains incompletely understood. The aim of our work was to analyze the perturbations of blood coagulation process for their possible impact on the etiology of lymphoceles. Additionally we performed an evaluation of the incidence and effectiveness of treatment methods for lymphoceles. MATERIALS AND METHODS During 2004 to 2010, we performed 242 kidney transplantations in 92 female and 150 male patients. The hemostatic parameters included concentrations of: antithrombin, plasminogen, thrombin/antithrombin complexes (TAT), prothrombin products F1+2 (F1+2), d-dimers, and plasmin/antiplasmin complexes. RESULTS At 7 years follow-up 27 (11%) recipients had developed symptomatic lymphoceles, namely abdominal discomfort, a palpable mess in the lower abdomen, arterial hypertension, infection of the operative site with fever, lymphorrhoea with surgical wound dehiscence, decreased diurnal urine output with an elevated plasma creatinine, voiding problems of urgency and vesical tenesmus, and/or symptoms of deep vein thrombosis. We applied the following methods of treatment aspiration alone, percutaneous drainage, laparoscopic fenestration or open surgery. In two only patients did perform open surgery. Since 2008 we have not performed an aspiration alone because of high rate of recurrence (almost 100%) and abandoned open surgery in favor of a laparoscopic approach. Our minimally invasive surgery includes percutaneous drainage guided by ultrasound and a laparoscopic procedure with 100% effectiveness. The examined hemostatic parameters revealed decreased concentrations of TAT complexes and F1+2 in subjects with lymphocele showing positive predictive values of 33% and 41% respectively. The negative predictive values for TAT complexes and F1+2 were 14% and 10%, respectively, suggesting decreased blood coagulation activity among effected recipients. Altered blood coagulation processes may explain some aspects of the disturbances of postoperative obliteration of damaged lymphatic vessels and formation of pathological lymph collection afterward. CONCLUSIONS Perturbations of blood coagulation may be one cause for a lymphocele.
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Affiliation(s)
- Z Ziętek
- Department of Clinical Anatomy, Pomeranian Medical University, Szczecin, Poland; Clinic of Gastrointestinal Surgery, Pomeranian Medical University, Szczecin, Poland
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[Current value of laparoscopy for renal transplantation]. Urologe A 2009; 48:1478-82. [PMID: 19936697 DOI: 10.1007/s00120-009-2187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Laparoscopic techniques have not only become increasingly more important for patients on dialysis or after kidney transplantation, they also represent the operative standard procedures as almost all patients additionally suffer from concomitant diseases and do carry a higher operative risk. Therefore, these patients will derive special benefits from minimally invasive procedures offering lower morbidity and quick recovery. In centers with expertise in minimally invasive procedures, laparoscopic donor nephrectomy has already replaced open live donor nephrectomy as the standard procedure.
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Ulrich F, Niedzwiecki S, Fikatas P, Nebrig M, Schmidt SC, Kohler S, Weiss S, Schumacher G, Pascher A, Reinke P, Tullius SG, Pratschke J. Symptomatic lymphoceles after kidney transplantation - multivariate analysis of risk factors and outcome after laparoscopic fenestration. Clin Transplant 2009; 24:273-80. [DOI: 10.1111/j.1399-0012.2009.01073.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cakmak A, Akyol C, Can OS, Hazinedaroglu SM. Identification of post-transplant lymphocele using lymphatic mapping with isosulphane blue. Clin Transplant 2009; 23:137-9. [DOI: 10.1111/j.1399-0012.2008.00940.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Król R, Kolonko A, Chudek J, Ziaja J, Pawlicki J, Mały A, Kunsdorf-Wnuk A, Cierpka L, Wiecek A. Did volume of lymphocele after kidney transplantation determine the choice of treatment modality? Transplant Proc 2008; 39:2740-3. [PMID: 18021974 DOI: 10.1016/j.transproceed.2007.08.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lymphocele is a lymph collection that forms after surgery following injury to lymph nodes and vessels. The aim of the study was to perform a retrospective analysis of different treatment modalities of lymphocele in patients after kidney transplantation. MATERIAL AND METHODS A lymphocele located in renal graft area was observed in 25 of 386 transplanted patients (6.5%). Mean patient age was 45 (95% confidence interval [CI], 40 to 50) years. Mean observation time was 35 (95% CI, 27 to 43) months. RESULTS Mean time from transplantation to diagnosis of lymphocele was 29 days (range, 4 to 127). In 13 patients (54.2%), the lymphocele was symptomatic, requiring initial treatment by repeated needle aspirations or percutaneous drainage. Among 7 patients with persistence of the lesion treatment by sclerotherapy with doxycycline, povidone-iodine, and/or ethanol was successful in 4 cases who showed maximal lymphocele volume of 500 mL. Three other patients, namely, volumes of 120, 874, and 2298 mL were referred for surgery; in two cases, internal marsupialization was performed and in one case external drainage was necessary due to abscess formation. Mean time from the diagnosis to recovery in patients requiring surgical treatment was 15 (range, 8 to 24) weeks. Eleven patients with asymptomatic lymphoceles (mean volume 45 mL; range, 8 to 140) were monitored to resolution after a mean of 4 (range, 1 to 11) weeks. CONCLUSION All lymphoceles with the maximal volume exceeding 140 mL were clinically symptomatic. Initial percutaneous drainage with or without sclerotherapy was an effective method of treatment. Punctures, drainage, and sclerotherapy were not effective in patients with lymphoceles (>500 mL).
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Affiliation(s)
- R Król
- Department of General, Vascular and Transplant Surgery, Katowice, Poland.
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LiteratureWatch. July-December 2005. J Endourol 2006; 20:362-8. [PMID: 16724911 DOI: 10.1089/end.2006.20.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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