Treatment of lymphocele in renal transplant recipients by laparoscopic fenestration after transcutaneous staining

Schilling, M.; Abendroth, D.; Kunz, R.

doi:10.1002/bjs.1800820237

Cited by 29 publications

(19 citation statements)

References 13 publications

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“…These include methylene blue instillation to distend and mark the cavity [21] and preoperative wire localization with ultrasound or CT guidance [25]. The successful use of intraoperative transcutaneous or laparoscopic ultrasound has also been described, although the ability to identify the ureter varies [19].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic treatment of post renal transplant lymphoceles

et al. 2003

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Section: Discussionmentioning

confidence: 99%

Laparoscopic treatment of post renal transplant lymphoceles

et al. 2003

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“…Laparoscopic peritoneal drainage has slowly moved into the focus of attention during recent years [15,16,21,22] . This technique requires greater operative skill and supportive facilities than percutaneous approaches.…”

Section: Discussionmentioning

confidence: 99%

“…According to positive results in the treatment of posttransplant lymphoceles [15,16] , we established a simplifi ed laparoscopic transperitoneal marsupialization of iliac lymphoceles after pelvic lymphadenectomy in patients with prostate cancer using methylene blue instillation.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Peritoneal Drainage of Symptomatic Lymphoceles after Pelvic Lymph Node Dissection Using Methylene Blue Instillation

Varga¹,

Hegele²,

Olbert³

et al. 2006

Urol Int

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Background: Lymphoceles are frequent complications of pelvic lymph node dissection. While small lymphoceles often remain undetected, larger ones can cause complications and require further treatment, e.g. percutaneous tube drainage alone or in combination with sclerotherapy. However, recurrence rates are considerable, and long-lasting drainage may lead to infection, prolonged hospitalization, and as a consequence, increased overall costs. We report the results of a simplified laparoscopic approach to drain lymphoceles after radical prostatectomy plus pelvic lymphadenectomy using methylene blue instillation. Methods: 13 patients with large symptomatic pelvic/retroperitoneal lymphoceles refractory to percutaneous tube drainage and doxycycline sclerotherapy received a laparoscopic transperitoneal marsupialization following instillation of a sterile diluted methylene blue solution into the drained cavity to refill and mark the lymphocele. Results: All lymphoceles were sterile and ranged in size from 7 × 6 × 4 to 15 × 12 × 6 cm. Clinical symptoms included lower abdominal swelling, tenderness in the iliac fossa, ipsilateral lymphedema, deep venous thrombosis, wound fistula, and hydronephrosis due to ureteral obstruction. After methylene blue instillation, the lymphoceles were easily identified and opened. Median total operative time was 50 (range 25–70) min; blood loss was negligible. There was one complication in the form of a metachronous infection in the operating field and no relapses. Patients were discharged 1–5 (median 3) days after the surgical procedure. Conclusions: Laparoscopic peritoneal drainage requires greater operative skill than percutaneous approaches. However, the instillation of a methylene blue solution simplifies this procedure as the extent and location of the lymphoceles can be precisely identified during laparoscopy. We recommend early application of laparoscopic peritoneal drainage following methylene blue instillation for patients with sterile lymphoceles after pelvic lymph node dissection in whom temporary percutaneous drainage and sclerotherapy failed to resolve the lymph fluid collection.

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“…The laparoscopic approach offers the advantages of minimal trauma and fast recovery, as concluded by almost all authors [l, 5,8,10,13,19,211. However, according to several reports [lo, 13,17,201, and demonstrated by our early experience, there is a significant risk of injury to vital structures (ureter/renal pelvis/ bladder/iliac vessels).…”

Section: Discussionmentioning

confidence: 99%

Improvement of post-transplant lymphocele treatment in the laparoscopic era

et al. 2002

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Post-transplant lymphoceles are a common problem after renal transplantation, often inflicting the graft or adjacent iliac veins. Since 1991, there have been many reports on laparoscopic fenestration as the treatment of choice, but no larger series has been presented. At our department, 63 laparoscopic procedures were performed between 1993 and 2001 among 1502 renal graft recipients. The laparoscopic operation time, conversion rate, hospital stay, and complications have all decreased progessively. Duration of hospital stay and convalescence was markedly longer in patients treated with conventional open surgery (27 patients). Rejections, CMV disease, and post-transplant reoperations seem to have an increased incidence in the lymphocele population. According to our experience, laparoscopic fenestration is the superior treatment for symptomatic lymphoceles, allowing minimal trauma and fast recovery. Our series suggests that the rate of complications/graft injury decreases progressively with experience. Laparoscopic ultrasound seems useful in difficult cases. Prophylactic measures should be emphasised at the time of transplantation and reoperations.

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Treatment of lymphocele in renal transplant recipients by laparoscopic fenestration after transcutaneous staining

Cited by 29 publications

References 13 publications

Laparoscopic treatment of post renal transplant lymphoceles

Laparoscopic treatment of post renal transplant lymphoceles

Laparoscopic Peritoneal Drainage of Symptomatic Lymphoceles after Pelvic Lymph Node Dissection Using Methylene Blue Instillation

Improvement of post-transplant lymphocele treatment in the laparoscopic era

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