#132 Electrocauterization versus ligation of lymphatic vessels to prevent lymphocele development after kidney transplantation—a meta-analysis

Abstract

Abstract Background and Aims Lymphoceles are amongst the most common complications following kidney transplantation. They can cause pain, discomfort, and even transplant malfunction or graft loss through the application of pressure on the graft as well as its surrounding structures. Therefore, effective strategies to prevent their development are needed. The ligation of lymphatic vessels has proven to be a successful concept for that purpose. However, whether electrocauterization or suture ligation is more effective is unclear. Method We conducted a meta-analysis using a random effects model with the log risk ratio as primary outcome measure. Additionally, an analysis using a random effects model with the raw mean difference in lymphatic sealing time between suture ligation and electrocauterization was performed. Adequate studies were found in a literature research conducted on PubMed and Web of Science as well as from independent sources. Results A total of 7 studies including 511 patients were included in the analysis. 16/244 (6.5%) lymphoceles were observed in the electrocauterization group and 28/267 (10.5%) in the suture ligation group, resulting in an overall incidence of 44 (8.6%) in the total population. The estimated average log risk ratio based on the random-effects model was µ=−0.349 (95% CI: −0.934 to 0.235), not significantly different from zero (z=−1,17, p=0.241). Lymphatic sealing time was 7.28 (95% CI: 1.25-13.3, p=0.018) minutes shorter in the electrocauterization group. Conclusion We conclude that neither technique is superior for the purpose of lymphocele prevention post kidney transplantation and secondary criteria like time saving, cost and surgeons’ preference should be considered in the decision for optimal outcome. However, it is unclear whether these results can be generalized for all patients.