title: Prophylactic peritoneal fenestration to prevent morbidity after kidney transplantation: a randomized study.
abstract: BACKGROUND
  Formation of lymphocele (accumulation of lymphatic fluid) is a common surgical complication following kidney transplantation. This open randomized trial evaluated the effect of prophylactic fenestration on lymphocele formation.
  
  
  METHODS
  Adult recipients of kidney grafts from deceased donors were randomized to undergo peritoneal fenestration during the transplantation or to standard surgical procedure without fenestration. The incidence of symptomatic lymphocele in the two groups was compared at 1 year after transplantation. A protocol-based ultrasound examination was performed in the 1st, 5th, and 10th postoperative week. Any hypoechoic perirenal collection was registered.
  
  
  RESULTS
  One hundred thirty recipients were randomized to peritoneal fenestration (n = 69) or standard therapy (n = 61). Six patients were excluded. Nine of 58 (15.5%) patients in the standard group developed symptomatic lymphoceles requiring treatment during the first postoperative year, versus 2 of 66 (3.0%) in the fenestration group (relative risk = 0.20, 95% confidence interval: 0.04-0.82, P = 0.015). Seven major surgical procedures and five percutaneous drainages due to lymphoceles were performed in the standard group, compared with two percutaneous drainages in the fenestration group. The prevalence of fluid collections in the fifth postoperative week was significantly higher in the standard group (66% vs. 37%; relative risk = 0.57, 95% confidence interval: 0.37-0.71, P = 0.005).
  
  
  CONCLUSIONS
  Prophylactic fenestration reduced the risk of lymphoceles and the need for invasive procedures to treat this condition. The results need to be confirmed in a population of transplant recipients on lower steroids and with the use of wound drains.
authors: Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Trygve
authors: T
authors: Syversveen
authors: Karsten
authors: K
authors: Midtvedt
authors: Knut
authors: K
authors: Brabrand
authors: Ole
authors: O
authors: Øyen
authors: Aksel
authors: A
authors: Foss
authors: Tim
authors: T
authors: Scholz