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Prevention and management of lymphocele formation following kidney transplantation. Transplant Rev (Orlando) 2017; 31:100-105. [DOI: 10.1016/j.trre.2016.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
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Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med 2016; 34:2200-2208. [DOI: 10.1016/j.ajem.2016.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023] Open
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Friedersdorff F, Roller C, Baumunk D, Giessing M, Miller K, Weikert S, Fuller TF. [Incarcerated hernia after laparoscopic drainage of a lymphocele]. Urologe A 2010; 49:1169-71. [PMID: 20464365 DOI: 10.1007/s00120-010-2323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laparoscopic lymphocele drainage is considered the gold standard for the treatment of lymphoceles after kidney transplantation. We report on a female patient who developed a symptomatic posttransplant lymphocele. After laparoscopic lymphocele drainage the patient presented with acute pain in the left lower abdomen. A CT scan showed a hernia into the peritoneal window. This is a rare but potentially severe complication after intraperitoneal lymphocele drainage. CT imaging and swift reoperation with enlargement of the peritoneal window are critical to avoid serious complications. To avoid bowel incarceration, the peritoneal window should be as large as possible.
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Affiliation(s)
- F Friedersdorff
- Klinik für Urologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Smyth GP, Beitz G, Eng MP, Gibbons N, Hickey DP, Little DM. Long-Term Outcome of Cadaveric Renal Transplant After Treatment of Symptomatic Lymphocele. J Urol 2006; 176:1069-72. [PMID: 16890692 DOI: 10.1016/j.juro.2006.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Between January 1993 and December 2002 a total of 1,289 renal transplants were performed at our institution. Symptomatic post-transplant lymphocele presenting as increased creatinine and hydronephrosis of the allograft was recorded at 0.02%. Records of the 27 patients in whom symptomatic lymphocele developed and of those who underwent contralateral kidney transplant (control group) were compared to determine the long-term effects of lymphocele formation on allograft function. MATERIALS AND METHODS A total of 37 procedures for the treatment of lymphocele were performed in 24 patients. Open marsupialization (12) and laparoscopic marsupialization (3) procedures were performed as primary treatments. Two patients underwent repeat open marsupialization. Aspiration and percutaneous catheter drainage were performed as a primary procedure in 7 and 1 cases, respectively. Percutaneous nephrostomy was required in 4 cases before definitive treatment. RESULTS The mean time to development of a lymphocele was 121 days (range 35 to 631). Symptomatic lymphocele did not require treatment in 3 patients. Of 19 patients undergoing primary marsupialization, recurrence in 2 necessitated repeat surgery. However, aspiration and percutaneous drainage proved to be definitive in only 2 cases. In total 8 patients required more than 1 procedure. At a mean followup of 63 months (SD 30.3) 21 allografts continued to function with a mean serum creatinine of 152 mumol/l (SD 67.9). In the control group 3 patients experienced graft failure and mean serum creatinine was 154 mumol/l (SD 51.9). Five patients died in the lymphocele group, 2 with functioning grafts compared to 4 deaths in the control group. CONCLUSIONS Surgical marsupialization is the preferred primary treatment for symptomatic lymphocele and is associated with excellent long-term allograft outcome.
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Affiliation(s)
- G P Smyth
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
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Hamza A, Fischer K, Koch E, Wicht A, Zacharias M, Loertzer H, Fornara P. Diagnostics and Therapy of Lymphoceles After Kidney Transplantation. Transplant Proc 2006; 38:701-6. [PMID: 16647449 DOI: 10.1016/j.transproceed.2006.01.065] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization. There was no connection between lymphocele formation and the following parameters: the extent to which the iliac vessels had been prepared, the materials used for the preparation, or whether clips or ligatures were applied. Lymphoceles may originate either from the lymphatic system of the recipient or the transplanted kidney. The most sensible measures to prevent their occurrence therefore seems to be to restrict the transplant bed to the smallest permissible level with careful ligature of the lymphatic vessels in the area of the kidney hilus. Treatment for lymphoceles should start with minimally invasive measures. We use the following algorithm in our clinic: puncture to differentiate between urinoma/lymphocele and to test for bacterial infection, sclerotization (200 mg doxycyclin), and finally marsupialization if persistent. The choice of operative technique depends on the location. This algorithm resulted in a relapse rate of 9.5% during the postoperative observation period of up to 15 years.
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Affiliation(s)
- A Hamza
- Department of Urology and Transplant Center of the Martin Luther University, Halle-Wittenberg, Halle, Germany
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Dubeaux VT, Oliveira RM, Moura VJ, Pereira JMS, Henriques FP. Assessment of lymphocele incidence following 450 renal transplantations. Int Braz J Urol 2005; 30:18-21. [PMID: 15707508 DOI: 10.1590/s1677-55382004000100004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Accepted: 02/16/2004] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the incidence of lymphocele in the follow-up of patients who underwent renal transplantation, as well as potential factors responsible or associated to its development. MATERIALS AND METHODS All records from patients who were treated for lymphocele in our institution between May 1989 and December 2002 were reviewed, as well as their clinical outcome following treatment. RESULTS Among 450 patients who underwent renal transplantation in the period, only 3 required treatment, with 2 of them treated due to the collection volume, and the other due to symptoms (pain), representing an incidence of only 0.6%. COMMENTS The occurrence of perirenal fluid collections following renal transplantation is frequent. In cases where treatment is required, this can generate an excessive morbidity for the patient, which motivates the development of preventive methods, such as minimally invasive therapy, for such cases. CONCLUSION Careful ligation of lymphatic vessels both during graft preparation and during its implantation, added to post-operative drainage can significantly contribute to reducing the incidence of lymphocele following renal transplantation.
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Affiliation(s)
- Victor T Dubeaux
- Section of Urology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Atray NK, Moore F, Zaman F, Caldito G, Abreo K, Maley W, Zibari GB. Post transplant lymphocele: a single centre experience. Clin Transplant 2004; 18 Suppl 12:46-9. [PMID: 15217407 DOI: 10.1111/j.1399-0012.2004.00217.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The occurrence of post renal transplant lymphocele is variable and the best approach to treatment is not well defined. The purpose of this study was to find out the incidence of post transplant lymphocele at our centre, identify demographic or surgical factors that may have influenced lymphocele formation, and distinguish the best approach to treatment. The charts of 138 consecutive renal transplant recipients from 1996 to 2001 were retrospectively reviewed. The demographic characteristics, comorbid illnesses, occurrence of lymphocele and its treatment modality were recorded. A total of 36 (26%) patients developed lymphoceles. There was a significant relationship between an increased body mass index (BMI) and lymphocele occurrence (P > 0.01). The recurrence rate with drainage alone was 33%, which decreased to 25% with sclerotherapy. In comparison, both laparoscopic and open surgical marsupialization had a much lower but similar recurrence rate of 12%. The laparoscopic method had less morbidity, a shortened hospital stay, and less infection than open surgery.
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Affiliation(s)
- Naveen K Atray
- Division of Nephrology, Regional Transplant Center of Willis Knighton and Louisiana State University Health Sciences Center, Shreveport, 71130, USA.
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Chin AI, Ragavendra N, Hilborne L, Gritsch HA. Fibrin sealant sclerotherapy for treatment of lymphoceles following renal transplantation. J Urol 2003; 170:380-3. [PMID: 12853780 DOI: 10.1097/01.ju.0000074940.12565.80] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Fibrin sealant is used in various surgical fields for hemostasis and as an adhesive to approximate tissues. Its use was recently reported as a sclerosing agent for percutaneous treatment of lymphoceles following renal transplantation. We report on the use of fibrin glue sclerotherapy at this institution for the management of renal transplant related lymphoceles. MATERIALS AND METHODS We reviewed the records of 8 patients at a single institution with lymphoceles after renal transplantation treated with percutaneous fibrin glue sclerosis. RESULTS Treatment success was achieved in 6 patients (75%), with resolution of lymphoceles assessed with clinical and imaging findings. Four patients (50%) required 2 applications of fibrin sealant, with 2 (25%) subsequently requiring surgical management of the lymphoceles. Clinical followup averaged 27.7 months (range 4 to 44). Complications included lymphocele recurrence, clogging of drainage catheters and catheter dislodgement. CONCLUSIONS The experience of 8 patients suggests that fibrin glue sclerotherapy may be considered a safe and effective method of treating symptomatic lymphoceles when simple percutaneous drainage has failed. The percutaneous approach does not require hospital admission and is less invasive than surgical treatment.
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Affiliation(s)
- Arnold i Chin
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA
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Doehn C, Fornara P, Fricke L, Jocham D. Laparoscopic fenestration of posttransplant lymphoceles. Surg Endosc 2002; 16:690-5. [PMID: 11972216 DOI: 10.1007/s00464-001-9150-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2001] [Accepted: 09/26/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND A lymphocele is a common finding after renal transplantation and occurs in up to 20% of patients. The majority of patients are asymptomatic. However, once a lymphocele has become symptomatic (e.g., through transplant dysfunction) this condition has to be treated. We report our 9-year experience with laparoscopic lymphocele fenestration and discuss the current management options for posttransplant lymphoceles. METHODS Since 1993, 19 patients (11 males and 8 females; median age 56 years, range 22-68 years) of a total of 31 patients with a symptomatic posttransplant lymphocele have undergone laparoscopic fenestration of their lymphocele at a median of 66 days (range, 19-111 days) following successful renal transplantation in our department. As a first-line treatment, a percutaneous pigtail drainage catheter was inserted in all patients. In case of failure in resolving the fluid collection, the next step included sclerotherapy by instillation of tetracycline or ethanol into the lymphocele cavity in some cases. In patients with a persistent lymphocele, a laparoscopic lymphocele fenestration via a transabdominal approach was undertaken to achieve adequate drainage. RESULTS Primary laparoscopic lymphocele fenestration was successful in all except two patients, who required a conversion. The median operating time was 36 min (range, 20-70 min). Following the procedure, renal transplant function remained stable or returned to individually normal levels in all patients. Median duration of hospital stay was 4 days (range, 1-13 days). At median follow-up of 27 months, all patients were alive with a functioning transplant. CONCLUSIONS Laparoscopic lymphocele fenestration is reserved for patients in whom temporary drainage with or without sclerotherapy failed to resolve the fluid collection. In these cases the laparoscopic approach offers obvious technical and clinical advantages compared to open operative techniques.
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Affiliation(s)
- C Doehn
- Department of Urology, University of Luebeck Medical School, Ratzeburger Allee 160, 23538 Luebeck, Germany.
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Duepree HJ, Fornara P, Lewejohann JC, Hoyer J, Bruch HP, Schiedeck TH. Laparoscopic treatment of lymphoceles in patients after renal transplantation. Clin Transplant 2001; 15:375-9. [PMID: 11737112 DOI: 10.1034/j.1399-0012.2001.150602.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Postoperative lymphoceles after renal transplantation appear in up to 18% of patients, followed by individual indisposition, pain or impaired graft function. Therapeutic options are percutaneous drainage, needle aspiration with sclerosing therapy, or internal surgical drainage by conventional or laparoscopic approach. The laparoscopic procedure offers short hospitalisation time and quick postoperative recovery. From 1993 to 1997, 16 patients underwent laparoscopic fenestration of a post-renal transplant lymphocele, and were presented in a retrospective analysis. Three patients have had previous abdominal surgery. Following preoperative ultrasound and CT scan, 16 patients underwent laparoscopic drainage after drainage and staining of the lymphocele with methylene blue. No conversion was necessary. Mean operation time was 42 min, no intraoperative complications were seen. Oral nutrition and immunosuppression were continued on the day of surgery, and patients were discharged between the 2nd and 5th (median hospital stay 3.3 d) day after surgery. No recurrence was evident in a follow-up time of 15-54 months (median 31.4 months). Renal function remained unchanged in all patients postoperatively.
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Affiliation(s)
- H J Duepree
- Department of Surgery and Department of Urology, University Hospital Luebeck, Ratzeburger Allee 160, Luebeck, Germany.
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Abstract
An exponential increase has occurred in the use of laparoscopic surgery in patients who have undergone prior renal transplantation. The main indications are the treatment of symptomatic pelvic lymphoceles and native kidney nephrectomy for various reasons. Most reports have shown laparoscopy to be equally effective and less morbid than conventional open surgery. In addition to conferring the benefits of a minimally invasive approach, laparoscopy potentially offers three advantages specific to this immunosuppressed population of patients. First, it avoids the potential wound-related problems inherent in open surgery. Second, by reducing hospitalization, it reduces the risk for nosocomial infections. Third, by allowing an earlier resumption of oral intake, it enables the continuation of oral immunosuppression. Proper perioperative management of fluid and electrolyte balance is critical in this group of patients. Despite concerns, there is no evidence showing that laparoscopy adversely affects allograft function.
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Affiliation(s)
- M M Desai
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis 2001; 33 Suppl 1:S53-7. [PMID: 11389523 DOI: 10.1086/320905] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The most frequent infectious complication after renal transplantation is urinary tract infection. This article deals with antimicrobial prophylaxis, treatment of early and relapsing urinary tract infections, and management of asymptomatic bacteriuria in renal transplant patients. The incidence of lymphocele after renal transplantation varies, and its treatment is still controversial. Management options are discussed.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Hsu TH, Gill IS, Grune MT, Andersen R, Eckhoff D, Goldfarb DA, Gruessner R, Hodge EE, Munch LC, Nghiem DD, Nye A, Reckard CR, Shaver T, Stratta RJ, Taylor RJ. Laparoscopic lymphocelectomy: a multi-institutional analysis. J Urol 2000; 163:1096-8; discussion 1098-9. [PMID: 10737473 DOI: 10.1016/s0022-5347(05)67700-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Because symptomatic lymphoceles are infrequent, single center studies generally report small numbers of patients. We report a multi-institutional experience with and long-term outcome following laparoscopic lymphocelectomy in 81 patients. MATERIALS AND METHODS Data were obtained from 9 institutions at which at least 5 cases of laparoscopic lymphocelectomy had been performed. Baseline patient demographics, operative time and blood loss, special operative adjunct techniques, postoperative course, convalescence, complications and lymphocele recurrence data were collected and analyzed. RESULTS A total of 56 men and 25 women with a mean age of 41 years were included in the study. Lymphocele formed after renal transplantation in 78 patients (96%) and after pelvic lymph node dissection in 3 (4%). Average operating time was 123 minutes with a mean blood loss of 43 ml. Omentopexy was performed in 11 cases (13.6%). No intraoperative stenting of the transplant ureter was performed. Intraoperative complications consisted of laryngospasm, bladder injury, inferior epigastric artery injury and mild renal capsule hematoma in 1 patient each. Conversion to open surgery was required for repair of bladder injury in 1, repair of preexisting hernia in 1, unusually thickened lymphocele wall in 1 and inaccessible lymphocele location in 4 cases. Mean time to ambulation and resumption of regular diet was 1 day, and mean hospital stay was 1.5 days. Postoperative complications included trocar site hernia in 1 and urinary retention in 2. Convalescence averaged 2.5 weeks. During a mean followup of 27 months 5 patients (6%) had lymphocele recurrence. CONCLUSIONS Laparoscopic lymphocelectomy is safe, minimally invasive and effective. It is an excellent alternative to the conventional open surgical approach.
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Affiliation(s)
- T H Hsu
- Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA
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LAPAROSCOPIC LYMPHOCELECTOMY:. J Urol 2000. [DOI: 10.1097/00005392-200004000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol 1999; 162:765-70; discussion 770-1. [PMID: 10458362 DOI: 10.1097/00005392-199909010-00038] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The 4 most active centers of the laparoscopy working group of the German Urologic Association collected data about the complications associated with laparoscopic surgery in urology. MATERIALS AND METHODS At 4 centers 2,407 laparoscopies or retroperitoneoscopies were performed as of May 1998, including 776 for varicocelectomy, 259 for cryptorchidism, 481 for pelvic lymph node dissection, 351 for nephrectomy/heminephrectomy renal pathology, 139 for renal cyst resection, 58 for ureteral procedures, 44 for adrenalectomy, 41 for nephropexy, 41 for lymphocele fenestration, 40 for retroperitoneal para-aortic lymphadenectomy and 187 for other operations. The complications were evaluated, listed according to the anatomical specificity and grouped with respect to the surgical step during laparoscopy. RESULTS A total of 107 complications (4.4%) occurred. The re-intervention rate was 0.8% and the mortality rate was 0.08%. The complication rate depended on the difficulty of the procedure and averaged 1.0, 3.9 and 9.2%, respectively, for easy, difficult and very difficult operations. The majority were vascular injuries (1.7%) and visceral lesions (1.1%) followed by complications of healing and infection (0.8%). Only 0.2% of complications was associated with the access technique (trocar insertion), whereas most occurred during dissection (2.9%). The complication rate was 13.3% for the first 100 procedures and subsequently averaged 3.6%. CONCLUSIONS Critical documentation of experience from several institutions, especially for an analysis of complications of urological laparoscopy, is important for the development of this surgical technique. The overall complication rate is comparable to other specialties. Future technical developments in trocar insertion, tissue dissection and control of bleeding with our improved training program will further reduce the complication rate.
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Affiliation(s)
- D Fahlenkamp
- Department of Urology, Ruppiner Kliniken GmbH, Neuruppin, Germany
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Bischof G, Rockenschaub S, Berlakovich G, Längle F, Mühlbacher F, Függer R, Steininger R. Management of lymphoceles after kidney transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00970.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- L L Glass
- Department of Urology, University of Rochester School of Medicine, New York 14642, USA
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Abstract
OBJECTIVES To evaluate the use of laparoscopic techniques in patients with a renal transplant. METHODS Since 1992, 358 patients have undergone urologic laparoscopy at our hospital. Among these, 37 procedures (10.4%) were performed in patients with a renal transplant: 14 bilateral nephrectomies for severe drug-resistant hypertension, 9 marsupializations of symptomatic lymphoceles, 6 renal allograft biopsies in patients with clotting abnormalities, 6 unilateral nephrectomies, and 2 nephroureterectomies for recurrent episodes of pyelonephritis and symptomatic vesicoureteral reflux, respectively. RESULTS Five complications (14%) and three conversions (8%) occurred. Patients who underwent successful laparoscopic operations began mobilization and oral intake on the day after the operation. The hospital stay ranged from 1 to 6 days. In the nephrectomy groups, perioperative urine outputs remained stable and post-operative urine outputs were increased as compared with those in the perioperative period (P < 0.05). Post-operatively, serum creatinine remained stable or improved in patients who underwent nephrectomy or marsupialization of lymphocele. CONCLUSIONS Our results indicate that laparoscopic techniques are safe and effective in the treatment of patients with a renal transplant. Renal allograft function apparently is not affected by laparoscopic procedures.
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Affiliation(s)
- P Fornara
- Department of Urology, Medical University of Lübeck, Germany
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Matsuda T, Terachi T, Yoshida O. Laparoscopy in urology: present status, controversies, and future directions. Int J Urol 1996; 3:83-97. [PMID: 8689517 DOI: 10.1111/j.1442-2042.1996.tb00489.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T Matsuda
- Department of Urology, Kansai Medical University, Moriguchi, Japan
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Fahlenkamp D, Schönberger B, Loening SA. Laparoscopic diagnosis and therapy of an undescended testicle after renal transplantation. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1995; 29:339-40. [PMID: 8578280 DOI: 10.3109/00365599509180587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- D Fahlenkamp
- Urological Clinic, Charité Humboldt University of Berlin
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Esterl RM, Halff GA. The use of methylene blue in the identification of lymphoceles after renal transplantation. Urology 1995; 45:1088-9. [PMID: 7771019 DOI: 10.1016/s0090-4295(99)80146-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Schilling M, Abendroth D, Kunz R. Treatment of lymphocele in renal transplant recipients by laparoscopic fenestration after transcutaneous staining. Br J Surg 1995; 82:246-8. [PMID: 7538413 DOI: 10.1002/bjs.1800820237] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lymphocele is a rare cause of impairment of graft function after renal transplantation. Treatment ranges from external drainage to laparoscopic internal marsupialization. A therapeutic approach to the treatment of symptomatic lymphocele is described, which employs external drainage, if necessary followed by methylene blue staining and laparoscopic internal drainage, should conservative treatment fail. Five patients developed post-transplant lymphocele of varying size and were treated according to this protocol. Identification of the blue lymphocele at laparoscopy was straightforward and complete marsupialization was performed. After a mean follow-up of 8.4 months all patients are free from symptoms and have well functioning grafts.
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Affiliation(s)
- M Schilling
- Department of Thoracic and Vascular Surgery, University of Ulm, Germany
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Abstract
With the introduction of laparoscopic operating techniques in urology, this new minimally invasive method can now be used in the treatment of problematic calculi in the ureter. We report our first experience with laparoscopic laser ureterolithotomy.
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Affiliation(s)
- D Fahlenkamp
- Urologische Klinik der Charité, Medizinische Fakultät, Humboldt-Universität zu Berlin, Germany
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Ohl DA, Faerber GJ, Hurd WW. Urologic laparoscopy with a new blunt-tipped trocar: safe, rapid access without the use of fascial sutures. Urology 1994; 43:861-4. [PMID: 8197651 DOI: 10.1016/0090-4295(94)90153-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fifteen patients underwent successful laparoscopic procedures where a new blunt-tipped trocar was used both to gain initial access to and to insufflate the abdominal cavity. The use of this new trocar obviates the need for the use of the Veress needle and appears to be both time-saving and possibly safer. Unlike the Hasson-type trocar, the blunt trocar technique does not require the use of fascial sutures for prevention of air leaks.
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Affiliation(s)
- D A Ohl
- Department of Surgery, University of Michigan Medical Center, Ann Arbor
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