Laparoscopic drainage of lymphoceles after kidney transplantation: indications and limitations.
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.
Gruessner
R W
RW
University of Minnesota, Department of Surgery, Minneapolis 55455.
Fasola
C
C
Benedetti
E
E
Foshager
M C
MC
Gruessner
A C
AC
Matas
A J
AJ
Najarian
J S
JS
Goodale
R L
RL
D000293:Adolescent; D000328:Adult; D004322:Drainage / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics; D008210:Lymphocele / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014463:Ultrasonography