Treatment of recurrent symptomatic lymphocele after kidney transplantation with intraperitoneal Tenckhoff catheter.
OBJECTIVE
The incidence of lymphocele after kidney transplantation ranges from 0.6% to 16%. The management of lymphocele is still controversial. Percutaneous needle aspiration and external drainage, with or without the injection of sclerosing solutions, are associated with high recurrence and complication rates. Open or laparoscopic intraperitoneal marsupialization requires hospital admission, general anesthesia, and, sometimes, extensive surgical dissection.


METHODS
We report our experience treating recurrent symptomatic lymphocele with intraperitoneal drainage using a Tenckhoff catheter on an outpatient basis in 7 consecutive patients. In all cases, the lymphocele was diagnosed by abdominal ultrasonography 26 to 90 days after kidney transplantation. The mean diameter of the lymphocele was 14 +/- 6 cm. Percutaneous drainage was the initial approach, which was also used to differentiate between urinoma and lymphocele and to rule out infection. The lymphocele recurred within 1 month in all cases. The recurrent lymphoceles were treated on an outpatient basis using intraperitoneal drainage with a Tenckhoff catheter inserted into the lymphocele under ultrasound guidance. After administration of local anesthesia, two 1-cm vertical incisions were performed: one to access the lymphocele and the other to access the peritoneal cavity. A Tenckhoff catheter was inserted in the lymphocele and tunneled into the peritoneal cavity.


RESULTS
All procedures were completed on an outpatient basis without any complications. The catheter was removed 6 months later with no evidence of recurrent lymphocele at ultrasound follow-up in all cases.


CONCLUSIONS
This outpatient surgical approach using ultrasound-guided intraperitoneal drainage with a Tenckhoff catheter appears to be a simple, effective, and safe method for treating unilobular recurrent symptomatic lymphocele after renal transplantation.
Adani
Gian Luigi
GL
Department of Surgery and Transplantation, Udine University School of Medicine, Udine, Italy. adanigl@hotmail.com
Baccarani
Umberto
U
Risaliti
Andrea
A
Gasparini
Daniele
D
Sponza
Massimo
M
Montanaro
Domenico
D
Tulissi
Patrizia
P
De Anna
Dino
D
Bresadola
Vittorio
V
D000328:Adult; D000553:Ambulatory Care; D002404:Catheterization; D002408:Catheters, Indwelling; D004322:Drainage; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008210:Lymphocele / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity; D011183:Postoperative Complications / Q000628:therapy*; D012008:Recurrence