THE LAPAROSCOPIC MANAGEMENT OF POSTTRANSPLANT LYMPHOCELE

Background: The management of lymphocele in patients following kidney (KT) and kidney pancreas (KPT) transplants is evolving. Open surgery h as been the traditional treatment, but some authors have advocated lap aroscopic drainage in selected patients. Methods: We retrospectively r eviewed our results in lymphocele treatment since developing a laparos copic program at out institution. Results: Between May 1994 and June 1 995, 186 KTs and 48 KPTs were performed, and 1,354 patients are curren tly being followed. Eight patients developed symptomatic lymphoceles a n average of 26 months (range 4-59) following 6 KTs and 2 KPTs. All pa tients diagnosed were successfully drained laparoscopically, with no c onversions to open surgery. Laparoscopic ultrasound was used to help w ith localization of the fluid collection. Operative time averaged 59 m in, median hospital stay was 1 day (range 1-4), and there were no peri operative complications. Follow-up imaging was obtained on six patient s, 3-16 months following their procedures, and no recurrences were not ed. A review of the literature demonstrates a 5.3% rate of major compl ications and a 7% incidence of lymphocele recurrence. Conclusions: Int raoperative laparoscopic ultrasound can help localize fluid collection s and prevent organ injuries. Laparoscopic drainage of lymphocele foll owing transplantation results in minimal disability and an acceptable complication rate, although it is higher than with open drainage. Ther efore, laparoscopic drainage should be considered as primary treatment for all patients with symptomatic post-transplant lymphocele.