Retroperitoneoscopic nephrolympholysis and ureterolysis for management of intractable filarial chyluria

Purpose: To evaluate the feasibility of retroperitoneoscopic lymphatic disc onnection in patients with intractable filarial chyluria with the aim of re ducing the morbidity of the surgery. Patients and Methods: Two patients presented to us with intractable chyluri a. They did not respond to conservative measures and endoscopic sclerothera py, In view of the severe lipid and protein loss associated with recurrent bouts of chyluria, they merited surgical correction by lymphatic disconnect ion. Because this operation requires extensive mobilization within the retr operitoneum over a large area, it necessitates a large flank or midline inc ision. In order to reduce the incision-related morbidity, it was decided to undertake the procedure laparoscopically, The retroperitoneal route was ch osen for its obvious advantages, Results: Surgery was carried out uneventfully in both patients, with a mean operating time of 2 hours. The patients stayed in the hospital for an aver age of 2.5 days. Chyluria resolved in the immediate postoperative period, a nd they have been asymptomatic over a follow-up of 30 and 18 months. One pa tient had drainage of lymph for 5 days, which resolved spontaneously. Conclusions: The objectives of open surgery can be achieved by the minimall y invasive approach of retroperitoneoscopy. The new approach significantly reduces the incision-related morbidity without compromising the principles of open surgery. We propose five important steps necessary to avoid recurre nce and reduce postoperative morbidity.