SURGICAL DISCONNECTION OF LYMPHORENAL COMMUNICATION FOR CHYLURIA - A 15-YEAR EXPERIENCE

Objective To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria. Patients and met hods Seventy-eight patients (40 men and 38 women, age 22-58 years) wit h severe chyluria of variable duration (5 months to 14 years), underwe nt surgical disconnection of the lymphorenal communication after confi rming the diagnosis of chyluria by urine examination for fat globules, lymphangiography to delineate the side, site and extent of lymphorena l communication and cystoscopy to decide the side to be operated, The areolar tissue containing dilated lymphatics travelling to the kidney in the perirenal and hilar region was dissected and divided between li gatures. thus stripping these structures completely; only one side was operated at a time. Results All 78 patients were available for a mini mum follow-up of 1 year, with the longest follow-up 15 years, Lymphang iography showed unilateral communication in 52 (66%) and bilateral in 26 (34%), If the patient was given a high-fat meal before surgery, the intra-operative visualization of the lymphatics was improved. With un ilateral surgery, clearance was achieved in 74 (94) immediately, with final success in 69 (88%) patients. Of the 26 (34%) patients with bila teral lesions, nine (12%) required bilateral surgery, giving a clearan ce rate of 97%, In two cases of failure, repeat surgery was successful in one; thus the overall success rate was 95%. Conclusion Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications, Bilateral lymphorenal commun ication seen on lymphangiography does not always warrant bilateral sur gery.