Laparoscopic Ultrasound-Guided Drainage of Lymphoceles Following Renal Transplantation

Abstract

The development of a lymphocele is an uncommon but well-documented complication of renal transplantation. In most patients, lymphoceles remain asymptomatic, and no intervention is required. In some cases, however, lymphoceles become symptomatic and cause systemic and local manifestations. Ultrasonic scanning can easily diagnose and locate the size and position of perirenal fluid collections. Many of these patients can be managed conservatively by aspiration and drainage of the lymphocele under radiologic guidance. However, if the lymphocele remains symptomatic or reaccumulates after aspiration and drainage, surgical intervention may be required. We describe two different ultrasound-guided laparoscopic techniques for drainage of a perirenal lymphocele into the peritoneal cavity. Successful drainage was accomplished in 5 patients, with 1 patient suffering an injury to the ureter of the transplant kidney. Recommendations regarding patient selection and operative technique are presented.

Laparoscopic fenestration of posttransplant lymphoceles

“…Some authors suggest the use of an omentum ap to decrease the risk of lymphocele relapse, but others do not [3±5, 14,30]. Recently, laparoscopic fenestration of posttransplant lymphoceles has been reported in the literature (Table 4) [1,6,8,9,11,15,16,19,25,28,31,32,36,38].…”

“…In 1991, McCullough et al [27] published the ®rst case report about the laparoscopic fenestration of a lymphocele. This approach has gained much attention and is now routinely performed at specialized centers with good success rates (Table 4) [1,6,8,9,11,15,16,19,25,28,31,32,36,38]. The potential bene®t from the laparoscopic approach is the avoidance of wound complications, postoperative ileus, and the need for changing the oral immunosuppression.…”

“…The potential bene®t from the laparoscopic approach is the avoidance of wound complications, postoperative ileus, and the need for changing the oral immunosuppression. To an increasing number of authors, laparoscopic fenestration is considered the most appropriate treatment of lymphoceles, provided there is no evidence of infection [1,6,8,9,11,15,16,19,25,28,31,32,36,38]. From the technical stand point, a few measures have been suggested to ease the location of the lymphocele and to minimize the risks of damaging adjacent structures, such as renal pelvis and ureter, urinary bladder, and blood vessels.…”

Laparoscopic treatment of lymphocele after kidney transplantation

“…A second flexible endoscope used to transilluminate the lymphocele wall from the inside was described as a valuable tool for identifying the ureter in a report of a single case after a kidney-pancreas transplantation [21]. The availability of laparoscopic ultrasound probes raised hopes that it might be a simple and effective means for identifying the ureter, but we, like others [10], found the method useful for detecting the lymphocele, but not the ureter.…”

Management of Urinary Tract Infections and Lymphocele in Renal Transplant Recipients

“…Internal drainage of lymphocele by laparascopic surgery is the preferred technique in many centers, because it allows radical treatment with minimal trauma for the patient and helps to diminish hospitalization, convalescence, and costs [45][46][47][48][49][50][51] (A-II).…”