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Bipolar vessel sealing system versus silk ligation of lymphatic vessels in renal transplant recipient lymphatic complications: a randomized controlled trial

  • Urology - Original Paper
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Abstract

Purpose

This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients.

Methods

This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks.

Results

Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor's kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant.

Conclusions

This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques.

Trial registration number

UMIN000039354, Date of registration—2020, Feb 01.

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Authors and Affiliations

  1. Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

    Prem Raj Sigdel, Diwas Gnyawali, Bipendra D. K. Rai, Pawan Dhital, Purushottam Parajuli, Sampanna Chudal, Manish Pradhan, Sujeet Poudyal, Suman Chapagain, Bhoj R. Luitel, Pawan R. Chalise, Prem R. Gyawali & Uttam K. Sharma

  2. Department of Community Health Sciences, Patan Academy of Health Sciences, Patan, Nepal

    Jeevan Thapa

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  1. Prem Raj Sigdel
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  2. Diwas Gnyawali
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Sigdel, P.R., Gnyawali, D., Thapa, J. et al. Bipolar vessel sealing system versus silk ligation of lymphatic vessels in renal transplant recipient lymphatic complications: a randomized controlled trial. Int Urol Nephrol 53, 2477–2483 (2021). https://doi.org/10.1007/s11255-021-03003-5

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