TY - JOUR
T1 - Laparoscopic drainage of lymphoceles after kidney transplantation
T2 - Indications and limitations
AU - Gruessner, Rainer W G
AU - Fasola, Carlos
AU - Benedetti, Enrico
AU - Foshager, Mary C.
AU - Gruessner, Angelika C.
AU - Matas, Arthur J.
AU - Najarian, John S.
AU - Goodale, Robert L.
PY - 1995/3
Y1 - 1995/3
N2 - Background. Symptomatic lymphoceles are not uncommon after kidney transplantations. Surgical marsupialization with internal drainage is the treatment of choice. However, laparoscopic drainage is reportedly as effective, with only minimal trauma. Methods. We attempted 14 laparoscopic lymphocele drainages during a 3-year period and studied the indications and limitations, using intraoperative ultrasonography in all cases. Results. Laparoscopic drainage was successful in only 9 (64%) of 14 patients. A conversion to open laparotomy was necessary in five patients; their lymphoceles were lateral and either posterior or inferior to the kidney. Two patients with initially successful laparoscopic drainage required conversion to open laparotomy 21 and 83 days later; their lymphoceles were inferior to the kidney. Laparoscopic drainage shortened the median hospital stay by 4 days versus open surgical drainage and by 7 days versus conversion. Hospital costs for laparoscopic drainage averaged $7400 less versus open drainage and $10,300 less versus conversion. Conclusions. In patients with symptomatic lymphoceles medial and either superior or anterior to the kidney, laparoscopic drainage under intraoperative ultrasonographic guidance is easy, safe, and effective. It decreases hospitalization, convalescence, and costs. In patients with symptomatic lymphoceles lateral and either posterior or inferior to the kidney, laparoscopic drainage may fail because of anatomic inaccessibility and technical impracticability.
AB - Background. Symptomatic lymphoceles are not uncommon after kidney transplantations. Surgical marsupialization with internal drainage is the treatment of choice. However, laparoscopic drainage is reportedly as effective, with only minimal trauma. Methods. We attempted 14 laparoscopic lymphocele drainages during a 3-year period and studied the indications and limitations, using intraoperative ultrasonography in all cases. Results. Laparoscopic drainage was successful in only 9 (64%) of 14 patients. A conversion to open laparotomy was necessary in five patients; their lymphoceles were lateral and either posterior or inferior to the kidney. Two patients with initially successful laparoscopic drainage required conversion to open laparotomy 21 and 83 days later; their lymphoceles were inferior to the kidney. Laparoscopic drainage shortened the median hospital stay by 4 days versus open surgical drainage and by 7 days versus conversion. Hospital costs for laparoscopic drainage averaged $7400 less versus open drainage and $10,300 less versus conversion. Conclusions. In patients with symptomatic lymphoceles medial and either superior or anterior to the kidney, laparoscopic drainage under intraoperative ultrasonographic guidance is easy, safe, and effective. It decreases hospitalization, convalescence, and costs. In patients with symptomatic lymphoceles lateral and either posterior or inferior to the kidney, laparoscopic drainage may fail because of anatomic inaccessibility and technical impracticability.
UR - http://www.scopus.com/inward/record.url?scp=0028910665&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0028910665&partnerID=8YFLogxK
U2 - 10.1016/S0039-6060(05)80204-1
DO - 10.1016/S0039-6060(05)80204-1
M3 - Article
C2 - 7878535
AN - SCOPUS:0028910665
SN - 0039-6060
VL - 117
SP - 288
EP - 295
JO - Surgery
JF - Surgery
IS - 3
ER -