Laparoscopic treatment of lymphocele after kidney transplantation

Background: Laparoscopic treatment of pelvic lymphocele secondary to kidney transplant has gained popularity in the last few years, although lesions o f the urinary tract (ureter, renal pelvis, and bladder) have been reported frequently. To evaluate the result of this treatment and the associated ris k of urinary tract lesions, we reviewed our experience and reports in the m edical literature on open and laparoscopic surgery. Methods: From 1991 to 1999, we laparoscopically treated 12 patients (7 men and 5 women; median age, 43 years; range, 17-59 years) with symptomatic pel vic lymphocele causing a deterioration of renal function because of compres sion on the ureter in 10 of the 12 patients and lymphocele compression of t he iliac vein in the other 2 patients. In nine patients, the lymphocele wal l was opened and sutured to the peritoneum to keep the window open. In two patients, an omentoplasty was performed, and in the remaining patient, both techniques were used. All patients were followed up clinically with ultras ound and biochemistry for a median period of 33 months (range, 1-96 months) . Using Medline, we reviewed the medical literature from 1980 to 1998 and c ollected 252 cases in which operations had been performed to drain an inter nal lymphocele secondary to kidney transplantation. Results: Laparoscopic treatment was successful in 11 of the 12 patients. On e patient was converted to open surgery because of a lesion in the transpla nted ureter. One patient needed repeat laparoscopy 24 hours after the opera tion because of bleeding from the peritoneal window. The median duration of the operation was 120 min (range, 70-200 min), and the median postoperativ e hospital stay was 5; days (range, 2-12 days). None of the patients needed to discontinue oral cyclosporine assumption. The serum creatinine level dr opped significantly after surgery (p < 0.05). No symptomatic recurrences we re observed. Of the 252 patients found in the medical literature, in 129 th e procedure was performed with open surgery and in 123 laparoscopically (ou r 12 patients included). The prevalence of iatrogenic lesions to the urinar y tract increased threefold with the use of laparoscopic surgery (from 1.6% in open surgery to 7% in laparoscopy). The recurrence rate of symptomatic lymphocele, however, decreased from 15% to 4%. Conclusions: Laparoscopic drainage of posttransplantation lymphocele is a r elatively simple method for treating this complication, although it bears t he burden of an increased incidence of urinary tract lesions, as confirmed by a review of the literature. The major advantage of the laparoscopic appr oach is the absence of postoperative ileus with the opportunity to continue the enteral immunosuppressive regimen and a lower recurrence rate. These d ata suggest that laparoscopic lymphocele treatment might be considered the therapy of choice, provided the iatrogenic lesions of the urinary tract dim inish as more experience with this technique is gained.