One of the most often occurring complications after a kidney transplantation is a lymphocele.
Materials
The examined group consisted of 118 patients (70 males and 48 females) with end-stage renal disease (ESRD).
Results
Fourteen patients (12%) developed symptoms of lymphocele within an average time of 34 weeks. The clinical symptoms included the following: decreased 24-hour urine collection and increased creatinine level, abdominal discomfort, lymphorrhoea with surgical wound dehiscence, urgency, vesical tenesmus, and/or fever. Increased appearance of lymphocele was noticed in patients with diabetic nephropathy, congenital malformations of the urinary tract, and inflammatory diseases, including glomerulopathy and extraglomerular ones, after high-voltage radiotherapy and after removal of the renal graft. The methods of treatment and their efficacy were as follows: percutaneous aspiration with the ratio of recurrence 100%; ultrasound guided percutaneous drainage 50%; laparoscopic intraabdominal marsupialization 75%; and surgical intervention with favorable results.
Conclusions
Ultrasound-guided percutaneous drainage with a success rate greater than 50% should be recommended as the first line of treatment. As a minimal invasive surgery this kind of treatment does not interfere with subsequent internal drainage through an open or a laparoscopic surgery. Laparoscopy, a feasible, safe technique with a success rate of more than 80%, should be used routinely after unsuccessful percutaneous drainage.
aDepartment of the General Surgery and Transplantology, Pomerenian Medical Academy, Szczecin, Poland
bDepartment of Pathophysiology Medical College, Nicolai Copernicus University, Toruń, Poland
cDepartment of Internal Diseases and Nephrology, Pomerenian Medical Academy, Szczecin, Poland.
Address reprint requests to Zbigniew Ziȩtek, MD, PhD, Department of General Surgery and Transplantology, ul. Powst. Wlkp. 72, 70-111 Szczecin, Poland.
ABSTRACT