Laparoscopic drainage of lymphoceles after kidney transplantation

Indications and limitations

Rainer W G Gruessner, Carlos Fasola, Enrico Benedetti, Mary C. Foshager, Angelika C Gruessner, Arthur J. Matas, John S. Najarian, Robert L. Goodale

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)288-295
Number of pages8
JournalSurgery
Volume117
Issue number3
DOIs
StatePublished - 1995
Externally publishedYes

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Lymphocele
Kidney Transplantation
Drainage
Kidney
Laparotomy
Head Kidney
Hospital Costs
Ultrasonography
Length of Stay
Hospitalization

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic drainage of lymphoceles after kidney transplantation : Indications and limitations. / Gruessner, Rainer W G; Fasola, Carlos; Benedetti, Enrico; Foshager, Mary C.; Gruessner, Angelika C; Matas, Arthur J.; Najarian, John S.; Goodale, Robert L.

In: Surgery, Vol. 117, No. 3, 1995, p. 288-295.

Research output: Contribution to journalArticle

Gruessner, RWG, Fasola, C, Benedetti, E, Foshager, MC, Gruessner, AC, Matas, AJ, Najarian, JS & Goodale, RL 1995, 'Laparoscopic drainage of lymphoceles after kidney transplantation: Indications and limitations', Surgery, vol. 117, no. 3, pp. 288-295. https://doi.org/10.1016/S0039-6060(05)80204-1
Gruessner, Rainer W G ; Fasola, Carlos ; Benedetti, Enrico ; Foshager, Mary C. ; Gruessner, Angelika C ; Matas, Arthur J. ; Najarian, John S. ; Goodale, Robert L. / Laparoscopic drainage of lymphoceles after kidney transplantation : Indications and limitations. In: Surgery. 1995 ; Vol. 117, No. 3. pp. 288-295.
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abstract = "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.",
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