Laparoscopic Fenestration Versus Percutaneous Catheter Drainage for Lymphocele Treatment after Kidney Transplantation

Abstract

Background: Lymphocele is an occasional complication after kidney transplantation. Laparoscopic fenestration (LF) or percutaneous catheter drainage (PCD) is a widely accepted treatment of lymphocele. The aim of this study was to review the result of LF and to compare outcomes of LF with those of percutaneous catheter drainage (PCD). Patients and method: The number of 1363 patients underwent kidney transplantation between Sep 1999 and Jun 2011. Thirty-five patients (2.5%) had symptomatic lymphocele. Among these patients, 7 patients were treated by LF after PCD, 10 patients by LF only, and 18 patients by PCD only. Those patients were divided into two group according to the treatment method; (1) LF group (n=17) and (2) PCD only group (n=18). Results: Follow-up duration was 40.0±37.2 months after treatment of lymphocele and there were no recurrence in both groups. There were no differences in age, gender, diabetes prevalence, retransplant rate in both groups. But acute rejection episodes and sirolimus use were more frequent in LF group than PCD group (41.7% vs 5.6%, p=0.015, 35.3% vs 5.6%, p=0.028). The drainage amount of LF group at the first day was more than PCD group. Mean duration between PCD and LF was 5.8 ± 3.7 days in LF group. After catheter insertion, PCD group showed significant decrease of drainage amount in the very next day. However, there was no significant decrease of drainage amounts after catheter insertion in LF group (Fig. 1). Conclusions: PCD can be a good first line treatment for symptomatic lymphocele. However, when the first day drainage is over 500cc or decline of second day drainage is not over 40% of first day drainage, LF should be considered as a second line treatment. Figure 1. Change of drainage amount in each day after percutaneous catheter insertion.[Figure 1.]