Laparoscopic marsupialization of postrenal transplantation lymphoceles

Background and Purpose: Clinically significant post-transplantation lymphoceles are not uncommon. Surgical marsupialization with internal peritoneal drainage is the treatment of choice. We describe the successful laparoscopic formation of a peritoneal window for post-transplantation lymphocele drainage as an effective and minimally invasive procedure. Patients and Methods: Between August 1995 and September 2001, 135 consecutive renal transplantations were performed, and 9 patients developed clinically significant lymphoceles. Four of the nine patients were treated by laparoscopic drainage via a peritoneal window. Analysis of predisposing risk factors commonly associated with lymphoceles was performed. The surgical outcome was assessed. Results: Laparoscopic drainage was successful in all patients. The average operative time was 40 minutes. The mean hospital stay was 1.5 days for patients undergoing laproscopic drainage versus 5 days for those having open surgical drainage. Accidental division of the right native ureter occurred in one patient, which was identified intraoperatively. None of the patients had developed recurrence of lymphocele after a mean follow-up of 10.7 months (range 6-22) months. Conclusion: In patients with a clinically significant post-transplantation lymphocele of appropriate size and location, laparoscopic drainage is easy, safe, and effective. It decreases hospital stay and hastens convalescence.