[Pelvic lymphoceles after kidney transplantation. Intraperitoneal marsupialization by celioscopy].
OBJECTIVE
The appropriate treatment for symptomatic pelvic lymphoceles occurring after renal transplantation is still debated. External drainage exposes to risk of recurrence, infection or graft sclerosis and laparotomy has been required for intraperitoneal marsupialization in patients at risk. We report our experience with two cases treated by laparoscopic intraperitoneal marsupialization.


METHODS
From November 1986 to September 1992, 170 renal transplantations were performed at our University Hospital. Lymphoceles developed in 12 cases and percutaneous puncture and irrigation was performed in all, successfully in 10. Relapse occurred in 2 patients--one 50-year-old woman with chronic glomerulonephritis and one 41-year-old man on peritoneal dialysis for polycystic renal disease--recipients of cadaver kidneys.


METHODS
The laparoscopy was conducted under general anaesthesia. Four trocars were inserted, a 10 mm via the umbilicus for the optical system and three 5 mm trocars via the right and left flank and the left iliac fossa. A long puncture needle was used to drain the lymphocele and a localized collection and a large peritoneal window was created. The abdominal cavity was abundantly washed before withdrawing.


RESULTS
Operation time was 35 minutes and conversion to laparotomy was not required. The only complication was a haematoma at one insertion site. Patients were discharged on day 2 and on day 1 with an unchanged immunosuppressor regimen. At 10 months follow-up, the patients were symptom-free and echography was normal.


CONCLUSIONS
Surgical treatment of lymphoceles can be successfully performed by laparoscopy. The choice between conservative treatment and laparoscopic surgery remains to be determined.
Le Roux
Y
Y
Service de Chirurgie générale, viscérale et digestive, CHU Côte de Nacre, Caen.
Bottet
P
P
Brefort
J L
JL
Dornier
L
L
Hurault de Ligny
B
B
Samama
G
G
D000328:Adult; D002908:Chronic Disease; D005260:Female; D005921:Glomerulonephritis / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy / Q000379:methods*; D008210:Lymphocele / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D007690:Polycystic Kidney Diseases / Q000601:surgery; D014057:Tomography, X-Ray Computed
Lymphocèles pelviennes après transplantation rénale. Marsupialisation intrapéritonéale par coelioscopie.