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128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

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SILS treatment of post-kidney transplantation lymphoceles

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  • Matthias Biebl - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Annemarie Weissenbacher - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Robert Öllinger - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Alexander Klaus - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Walter Mark - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Johann Pratschke - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch375

doi: 10.3205/11dgch375, urn:nbn:de:0183-11dgch3751

Published: May 20, 2011

© 2011 Biebl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Post kidney transplantation, lymphoceles occur in about 10%, depending on the immunosuppression used. Large or symptomatic fluid collections require intraperitoneal drainage. We report our expiences with a SILS approach to lymphocele fenestration.

Materials and methods: A 5 mm optic and standard single incision ports are used and the patient is positioned supine with the table tilted away from the lymphocele side. According to the patients size, the port is introduced via an umbilical/epigastric (in pediatric patients) incision. Idenifying the lymphocele due to buldging of the parietal peritoneum, endoscopic ultrasound is used to avoid the transplant ureter or iliac vessels. The lymphocele wall is excised and the fluid drained.

Results: A 15-years old patient presented with a large symptomatic lymphocele in his right iliac fossa 2 months following sucessful kidney transplantation for atypic hemolytic uremic syndrome. Maintainance immunosuppression consisted of tacrolimus, mycophenolic acid and steroids. Following futile conservative management, the lymphocele was drained in two locations in SILS technique using an Olympus Triport® system, followed by a renal biopsy for suspected relapse of the HUS. Due to the lymphocele location in the iliac fossa, standard straight instrumentats were used. Following an uneventful recovery, the serume creatinine declined postoperatively from 1.4 to 0.7 mg/dl.

Conclusion: SILS offers a minimally invasive, easy technique to lymphocele fenestration following kidney transplantation, even in pediatic patients, and is therefore suitable to become the standard approach for this procedure.