Renal pedicle lymphatic ligation for parasitic chyluria via retroperitoneal laparoscope: report of 22 cases

Abstract

Objective To investigate the clinical efficacy and application value of renal pedicle lymphatic disconnection via retroperitoneal laparoscope in the treatment of parasitic chyluria. Methods Clinical data of 22 patients diagnosed with parasitic chyluria admitted to our department from January 2012 to December 2016 were retrospectively analyzed, including 9 male and 13 female, aged 52-72 years (60.5 years on average), the course of disease ranging from 1 to 30 years (5.6 years on average). All patients were diagnosed with unilateral chyluria and treated with renal pedicle lymphatic disconnection under retroperitoneal laparoscope. Intraoperatively, the surrounding lymphatic vessels were fully ligated after the upper segment of the ureter and renal pedicle vessels were skeletonized. The operation time, intraoperative blood loss, the recovery time of postoperative intestinal function, the length of hospital stay and surgical efficacy during follow-up were analyzed. Results All 22 cases successfully completed the surgery. No conversion to open surgery was required. The operation time was 75-140 min (95 min on average). Intraoperative blood loss was 10-300 ml with a median volume of 65 ml. The recovery time of postoperative intestinal function was ranged from 10 to 24 h (16.5 h on average). The length of postoperative hospital stay was 4-9 d, 5.5 d on average. Intraoperatively, 1 patient presented with slight renal vein injury and 2 cases of retroperitoneal injury, which were successfully repaired under laparoscope. Two patients developed subcutaneous emphysema, which was mitigated by conservative treatment. All patients were followed up for 1 to 4 years, 2.3 years on average. No case recurred. Conclusion Renal pedicle lymphatic disconnection under retroperitoneal laparoscope yields high efficacy in the treatment of parasitic chyluria. It is an ideal surgical approach in primary hospitals in which certain experience has been accumulated in retroperitoneal laparoscopic operation. Key words: Laparoscopy; Renal pedicle lymphatic disconnection; Chyluria; Parasite