Authors
1
AL-Karama Teaching Hospital, Baghdad, Iraq
2
Gazi AL Hariri for Surgical Specialties Hospital, Medical City Baghdad, Iraq
,
Document Type : Research Paper
Abstract
ABSTRACT:
BACKGROUND:
Lymphocele is one of the common complications following renal transplantation, and usually present with persistent lymphatic drain in immediate post-transplant period or perigraft (between the kidney allograft and the urinary bladder) collection in post-transplant routine ultrasound (1). Lymphorrhea or lymphorragia is defined as a lymph leak from the surgical drains or from the abdominal wall through the surgical wound (2).
AIM OF STUDY:
To compare between lymphatic’s ligation and electrocauterization in reducing post kidney transplantation lymphocele.
PATIENTS AND METHODS:
design: Prospective comparative study. Setting: Kidney Transplant Center in Medical City. Study period: From the1st August 2017 till 1st August 2019. Sample size: 100 patients with end stage renal disease. Exclusion criteria (Death, graft loss within 4-6 weeks, lack of follow-up).
RESULTS:
In this study, we noticed that lymphocele formation was in 20% of patients who were managed by lymphatic electro cauterization which was significantly higher than that in patients who were managed by meticulous ligation of lymphatics (6%) (P= 0.037). Regarding the mean of duration until drain removal, was significantly higher in cautery group than that in ligation group (7.1 versus 5.8 days, P= 0.02). Intervention needed for symptomatic lymphocele was greater in patients managed by lymphatic electrocauterization which was statistically significant (P= 0.045).
CONCLUSION:
We found that a meticulous surgical technique with ligation of all lymphatics, was significant in reducing the incidence of lymphoceles following kidney transplantation in our recipients.
REFERENCES:
- Sengupta P, Biswas S, Sen S, Chowdhury S. Unusual presentation post renal transplant lymphocele. J Assoc Physicians India. 2014; 62:744.
- Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clinical kidney journal. 2015 ;8:615-22.
- Khan TFT, Baig MA. Post Kidney Transplant Lymphoceles: Meticulous Ligation of Lymphatics Reduces Incidence. UroToday International Journal [Internet]. Digital Science Press (Urotoday International Journal); 2011;04.
- Simforoosh N, Tabibi A, Rad HM, Gholamrezaie HR. Comparison Between Bipolar Lymphatic Vessels Cautery and Suture Ligature in Prevention of Postrenal Transplant Lymphocele Formation: A Randomized Controlled Trial. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 2019;17:26-30.
- Golriz M, Klauss M, Zeier M, Mehrabi A. Prevention and management of lymphocele formation following kidney transplantation. Transplantation Reviews. 2017;31:100-5.
- Gunawansa N, Sharma A, Halawa A. Lymphocele after renal transplantation: A new look at an age-old problem. J Renal Transplant Sci. 2019;2:73-7.
- Ziętek Z, Iwan-Ziętek I, Sulikowski T, Sieńko J, Nowacki M, Żukowski M, et al. The outcomes of treatment and the etiology of lymphoceles with a focus on hemostasis in kidney recipients: a preliminary report. InTransplantation proceedings 2011;43: 3008-12. Elsevier.
- Bardonnaud N, Pillot P, Lillaz J, Delorme G, Chabannes E, Bernardini S, et al. Outcomes of renal transplantation in obese recipients. InTransplantation proceedings 2012 ; 44: 2787-91. Elsevier.
- Zagdoun E, Ficheux M, Lobbedez T, Chatelet V, Thuillier-Lecouf A, Bensadoun H, et al. Complicated lymphoceles after kidney transplantation. InTransplantation proceedings 2010 ;42: 4322-325. Elsevier.
- Mokos I, Basic-Jukic N, Kastelan Z, Kes P, Pasini J. Influence of long-term dialysis treatment on operative complications after renal transplantation. In Transplantation proceedings 2010;42:2531-33. Elsevier.
- Derouiche A, El Atat R, Mechri M, Garbouj N, Ezzeddine A, Khaled A, et al. Post–kidney transplantation lymphocele due to a lymphatic filariasis. InTransplantation proceedings 2010; 42: 2808-12). Elsevier.
- Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, et al. A review of the postoperative lymphatic leakage. Oncotarget. 2017; 8:69062.
- Lima ML, Cotrim CA, Moro JC, Miyaoka R, D'Ancona CA. Laparoscopic treatment of lymphoceles after renal transplantation. International braz j urol. 2012; 38:215-21.
- Allen RD. Vascular and lymphatic complications after kidney transplantation. In Kidney Transplantation–Principles and Practice 2014 :435-63.
- Farouk K, Bano U, Ahmad N, Khan AR. Electocoagulation Versus Suture-Ligation of Lymphatics in Kidney Transplant Recipient surgery. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2011;20.
- Lucan CV, Jurchis I, Suciu M, Selicean SE, Buttice S. Modern lymphatic dissection techniques for preventing post renal transplant lymphocele. Clujul Medical. 2017; 90.
- Barba J, Rosell D, Rincon A, Robles JE, Zudaire J, Berian JM, et al. New immunosuppressive therapies and surgical complications after renal transplantation. In Transplantation proceedings 2012 ; 44: 1275-80). Elsevier.