The laparoscopic management of post-transplant lymphocele. A critical review.

BACKGROUND

The managements of lymphocele in patients following kidney (KT) and pancreas (KPT) transplantation is evolving. Open surgery has been the traditional treatment, but some authors have advocated laparoscopic drainage in selected patients.

METHODS

We retrospectively reviewed our results in lymphocele treatment since developing a laparoscopic program at our institution.

RESULTS

Between May 1994 and June 1995, 186 KTs and 48 KPTs were performed, and 1,354 patients are currently being followed. Eight patients developed symptomatic lymphoceles an average of 26 months (range 4-59) following 6 KTs and 2 KPTs. All patients diagnosed were successfully drained laparoscopically, with no conversions to open surgery. Laparoscopic ultrasound was used to help with localization of the fluid collection. Operative time averaged 59 min, median hospital stay was 1 day (range 1-4), and there were no perioperative complications. Follow-up imaging was obtained on six patients, 3-16 months following their procedures, and no recurrences were noted. A review of the literature demonstrates a 5.3% rate of major complications and a 7% incidence of lymphocele recurrence.

CONCLUSIONS

Intraoperative laparoscopic ultrasound can help to localize fluid collections and prevent organ injuries. Laparoscopic drainage of lymphocele following transplantation results in minimal disability and an acceptable complication rate, although it is higher than with open drainage. Therefore, laparoscopic drainage should be considered as primary treatment for all patients with symptomatic post-transplant lymphocele.