Treatment of lymphocele associated with renal transplant

Laparoscopic drainage of lymphocele after kidney transplant

Lymphocele can develop after renal transplantation. Surgical internal drainage to the abdominal cavity through a standard laparotomy is indicated for symptomatic persistent lesions. Internal drainage can be performed laparoscopically. In this report, we describe our laparoscopic surgical technique for drainage and analyze our results in five patients with lymphoceles that developed after kidney transplantation. All the patients were male, with a mean age of 29 +/- 10 years. The volume of fluid in the lymphoceles ranged from 500 to 1000 mL. Percutaneous drainage was selected as the initial treatment without success. A laparoscopic peritoneal window was created in all patients under intraoperative ultrasonographic guidance. The mean operative time was 90 minutes. In all patients, the fluid collections resolved after laparoscopic internal drainage without complications. During a mean follow-up of 3 +/- 2 years, all patients remained asymptomatic, and no additional fluid collections were identified.

Intraperitoneal drainage of recurrent lymphoceles using an internalized Tenckhoff catheter

Occasionally, lymphoceles recur after renal transplantation in relatively inaccessible pelvic locations, usually in the setting of a transversely oriented allograft that separates the lymphocele from the peritoneal cavity. Such lymphoceles do not share a common wall with the peritoneal cavity and, therefore, are not manageable by conventional open surgical or laparoscopic drainage techniques. We used an internalized Tenckhoff catheter to drain recurrent lymphoceles into the peritoneal cavity in 3 patients who had undergone prior renal transplantation. No evidence of lymphocele recurrence or catheter-induced septic complications have been noted in our immunocompromised patients up to a mean followup of 5.3 years. Our experience with this alternative management option for the recurrent, inaccessible lymphocele is presented along with a single case report of intractable, recurrent perinephric fluid collection in the nontransplant setting treated by the same technique.

Laparoscopic deroofing of post-transplant lymphoceles

Lymphocele is a most common surgical complication following renal transplantation. The indication for treatment is given when the lymphocele becomes symptomatic. We succeeded in laparoscopically deroofing large lymphoceles in nine patients that were causing ureter compression in eight and ipsilateral leg edema in six cases. The postoperative course was uneventful, and the surgery-related hospitalization did not exceed 7 days. Severe adhesions and a thick lymphocele wall, which made preparation difficult, resulted in the transection of the transplant ureter in one case. Techniques and prerequisites that would help to avoid this type of complication are discussed. According to CT scan or sonography, there was no recurrence in any of the patients after a mean follow-up of 11 months. This technique seems to be superior to other methods of treatment because not only is a cure obtained with a single intervention, but there is also a low risk of infection and a short hospitalization.

Treatment of persistent lymphatic drainage after laparoscopic pelvic lymph node dissection and radical retropubic prostatectomy

A patient with a lymphocele after laparoscopic pelvic lymphadenectomy and radical retropubic prostatectomy was treated successfully with a single instillation of diatrizoate meglumine through a Jackson-Pratt drain. The authors review the origin of lymphoceles and various methods for treating them.

The optimal treatment of lymphoceles following renal transplantation

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 management of lymphocele after pelvic lymphadenectomy and radical retropubic prostatectomy

A new method of managing pelvic lymphoceles after urologic procedures is described. A patient with a symptomatic pelvic lymphocele after pelvic lymph node dissection and radical retropubic prostatectomy was treated laparoscopically. Technical aspects of laparoscopic marsupialization of lymphoceles are described, and the laparoscopic approach is compared with other modalities available for treating lymphoceles.