title: Management of primary symptomatic lymphocele after kidney transplantation: a systematic review.
abstract: BACKGROUND
  Management of lymphoceles after kidney transplantation is highly variable. The aim of this study was to evaluate and compare the different approaches of lymphocele management among kidney transplant recipients.
  
  
  METHODS
  MEDLINE and EMBASE were systematically searched for case studies published between 1954 and 2010. Inclusion criteria were symptomatic lymphoceles developing in recipients of deceased or living donor kidneys with specified intervention and outcome. Primary outcome was the rate of recurrence. Secondary outcomes were the rate of conversion from laparoscopic to open surgery, hospital stay, and complication rates.
  
  
  RESULTS
  Fifty-two retrospective case series with 1113 cases of primary lymphocele were selected for review. No randomized controlled trials or prospective cohort studies were located. Primary treatment modalities included were as follows: aspiration (n=218), sclerotherapy (n=155), drainage (n=219), laparoscopic surgery (n=333), and open surgery (n=188). Of the 218 cases of lymphocele managed with aspiration alone, 141 recurred with a recurrence rate of 59% (95% confidence interval [CI]: 52-67). Among those who received laparoscopic and open surgery, the recurrence rates were 8% (95% CI: 6-12) and 16% (95% CI: 10-24), respectively. The conversion rate from laparoscopic to open surgery was 12% (95% CI: 8-16).
  
  
  CONCLUSIONS
  Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.
authors.affiliation: Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Ania
authors.initials: A
authors.lastname: Lucewicz
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Vincent W T
authors.initials: VW
authors.lastname: Lam
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Hawthorne
authors.forename: Richard
authors.initials: R
authors.lastname: Allen
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Henry C C
authors.initials: HC
authors.lastname: Pleass
mesh_terms: D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D019520:Living Donors; D008210:Lymphocele / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D015911:Sclerotherapy / Q000379:methods; D016896:Treatment Outcome