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Laparoscopic fenestration of posttransplant lymphoceles

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Abstract

Background

A lymphocele is a common finding after renal transplantation and occurs in up to 20% of patients. The majority of patients are asymptomatic. However, once a lymphocele has become symptomatic (e.g., through transplant dysfunction) this condition has to be treated. We report our 9-year experience with laparoscopic lymphocele fenestration and discuss the current management options for posttransplant lymphoceles.

Methods

Since 1993, 19 patients (11 males and 8 females; median age 56 years, range, 22–68 years) of a total of 31 patients with a symptomatic posttransplant lymphocele have undergone laparoscopic fenestration of their lymphocele at a median of 66 days (range, 19–111 days) following successful renal transplantation in our department. As a first-line treatment, a percutaneous pigtail drainage catheter was inserted in all patients. In case of failure in resolving the fluid collection, the next step included sclerotherapy by instillation of tetracycline or ethanol into the lymphocele cavity in some cases. In patients with a persistent lymphocele, a laparoscopic lymphocele fenestration via a transabdominal approach was undertaken to achieve adequate drainage.

Results

Primary laparoscopic lymphocele fenestration was successful in all except two patients, who required a conversion. The median operating time was 36 min (range, 20–70 min). Following the procedure, renal transplant function remained stable or returned to individually normal levels in all patients. Median duration of hospital stay was 4 days (range, 1–13 days). At median follow-up of 27 months, all patients were alive with a functioning transplant.

Conclusions

Laparoscopic lymphocele fenestration is reserved for patients in whom temporary drainage with or without sclerotherapy failed to resolve the fluid collection. In these cases the laparoscopic approach offers obvious technical and clinical advantages compared to open operative techniques.

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Authors and Affiliations

  1. Department of Urology, University of Luebeck Medical School, Ratzeburger Allee 160, 23538, Luebeck, Germany

    C. Doehn, P. Fornara & D. Jocham

  2. Department of Urology, Martin Luther University Medical School, Magdeburger Str. 16, 06097, Halle/Saale, Germany

    P. Fornara

  3. Department of Internal Medicine, University of Luebeck Medical School, Ratzeburger Allee 160, 23538, Luebeck, Germany

    L. Fricke

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  1. C. Doehn
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  3. L. Fricke
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  4. D. Jocham
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Doehn, C., Fornara, P., Fricke, L. et al. Laparoscopic fenestration of posttransplant lymphoceles. Surg Endosc 16, 690–695 (2002). https://doi.org/10.1007/s00464-001-9150-2

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