Does opening the peritoneum at the time of renal transplanation prevent lymphocele formation?
BACKGROUND
The occurrence of lymphocele formation following renal transplantation is variable, and the optimal approach to treatment remains undefined. Opening the peritoneum at the time of transplantation is one method of decreasing the incidence of lymphocele formation. The purpose of this study was to determine whether creating a peritoneal window at the time of transplantation decreases the incidence of lymphocele formation.


METHODS
We performed a retrospective review of renal transplants conducted at our institution between 2002 and 2004. Records were reviewed to obtain details regarding opening of the peritoneum at the time of transplant and occurrence of lymphocele. Every patient underwent routine ultrasound imaging in the peri-operative period. Graft dysfunction secondary to the lymphocele was the primary indication for intervention. Data were analyzed by chi-square.


RESULTS
During the initial transplant the peritoneum was opened in 35% of patients. The overall incidence of fluid collections, identified by ultrasound, was 24%. Opening the peritoneum did not decrease the incidence of lymphocele. However, more patients with a closed peritoneum required an intervention for a symptomatic lymphocele. In the 11 patients with an open peritoneum and a fluid collection, only one required an intervention. In patients whose peritoneum was left intact, 24% of fluid collections required intervention. Graft survival was equivalent.


CONCLUSIONS
Creating a peritoneal window at the time of transplantation did not decrease the overall incidence of postoperative fluid collections. However, forming a peritoneal window at the time of transplantation did decrease the incidence of symptomatic lymphocele.
Layman
R E
RE
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53208, USA. rlayman@mcw.edu
McNally
M
M
Kilian
C
C
Linn
J
J
Roza
A
A
Johnson
C P
CP
Adams
M B
MB
Shames
B D
BD
D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D008210:Lymphocele / Q000453:epidemiology / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies