Therapeutic and diagnostic algorithm for the treatment of lymphocele in renal transplant recipients

Abstract

Relevance. Retroperitoneal lymphocele is one of the most common complications in renal transplant recipients.Objective. To improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele by using a modern diagnostic and treatment algorithmMaterials and methods. Materials and methods: From June 2018 to March 2021 at the State Clinical Hospital named after S.P. Botkin, Moscow performed 174 kidney transplants from a posthumous donor. The accumulation of lymph in the retroperitoneal space was recorded in 24 patients, which amounted to 13.7%. Indications for surgical correction were found in 16 patients, which amounted to 9.1%. Computed tomography in 10 patients (62.5%) showed a wide adherence of the lymphocele cavity to the parietal peritoneum; peritoneum, the complexity of the planned laparoscopic surgery was assessed as high. These patients underwent laparoscopic peritoneal fenestration with ultrasound navigation. In 2 patients (12.5%), lymphocele adherence to the peritoneum was not revealed; these patients underwent open surgery.Results. Results: No relapses of lymphocele were detected after surgery. Mortality was not recorded. In the group of patients who underwent laparoscopic peritoneal fenestration with predictable low complexity, one postoperative complication was diagnosed – migration of the loop of the small intestine into the lymphocele cavity with subsequent infringement. The duration of hospitalization with laparoscopic intervention was 2.1 ± 0.43 (2–3) days, with open one it was 8.45 ± 3.25 (7–12) (p = 0.001).Conclusion. The use of a modern diagnostic and treatment algorithm can improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele.