LAPAROSCOPIC DRAINAGE OF LYMPHOCELES AFTER KIDNEY-TRANSPLANTATION - INDICATIONS AND LIMITATIONS

Background. Symptomatic lymphoceles are not uncommon after Kidney tran splantations. Surgical marsupialization with internal drainage is the treatment of choice. However, laparoscopic drainage is reportedly as e ffective, with only minimal trauma. Methods. We attempted 14 laparosco pic lymphocele drainages during a 3-year period and studied the indica tions and limitations, using intraoperative ultrasonography in all cas es. Results. Laparoscopic drainage was successful in only 9 (64%) of 1 4 patients. A conversion to open laparotomy was necessary in five pati ents; their lymphoceles were lateral and either posterior or inferior to the Kidney. Two patients with initially successful laparoscopic dra inage required conversion to open laparotomy 21 and 83 days later; the ir lymphoceles were inferior to the kidney. Laparoscopic drainage shor tened the median hospital stay by 4 days versus open surgical drainage and by 7 days versus conversion. Hospital costs for laparoscopic drai nage averaged $7400 less versus open drainage and $10,300 less versus conversion. Conclusions. In patients with symptomatic lymphoceles medi al and either superior or anterior to the kidney, laparoscopic drainag e under intraoperative ultrasonographic guidance is easy, safe, and ef fective. It decreases hospitalization, convalescence, and costs. In pa tients with symptomatic lymphoceles lateral and either posterior or in ferior to the kidney, laparoscopic drainage may fail because of anatom ic inaccessibility and technical impracticability.