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Laparoscopic fenestration of posttransplant lymphoceles in children
Barbara Gómez Dammeier1, Anja Lehnhardt, Sylvia Glüer
1Department of Pediatric Surgery, Medizinische Hochschule Hannover, Hannover, Germany.
Insights
Post-transplant lymphoceles in children are effectively treated with laparoscopic fenestration. This safe and minimally invasive procedure leads to rapid recovery of renal function and resolves complications like obstruction and pain.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Urology
Background:
- Lymphoceles are common surgical complications following renal transplantation.
- Data on pediatric post-transplant lymphoceles are limited compared to adults.
Purpose of the Study:
- To investigate the incidence, clinical presentation, and outcomes of post-transplant lymphoceles in pediatric kidney transplant recipients.
- To evaluate the efficacy and safety of laparoscopic fenestration for treating pediatric post-transplant lymphoceles.
Main Methods:
- Prospective observation of 5 pediatric patients (median age 6 years) who developed post-transplant lymphoceles after kidney transplantation.
- Clinical course, renal function, and ultrasound findings were monitored.
- All patients were treated with laparoscopic fenestration.
Main Results:
- Lymphoceles appeared between 13-48 days post-transplant, varying in size and location.
- Complications included decreased renal function (4 patients), urinary tract obstruction (2 patients), and abdominal pain (1 patient).
- Laparoscopic fenestration was safe and effective, with all patients showing recovery of renal function, resolution of obstruction and pain, and no observed relapses at 3-10 months post-surgery.
Conclusions:
- Laparoscopic fenestration is the preferred treatment for pediatric post-transplant lymphoceles due to its safety, effectiveness, and ease of performance.
- Early intervention with laparoscopic fenestration ensures immediate recovery of renal function.
Background/Purpose:
Lymphoceles are frequently observed as a surgical complication after renal transplantation. Whereas the frequency, pathogenesis, diagnosis, and treatment of lymphoceles has been well described in adult patients, no data are available for the pediatric age group.
Methods:
Since December 2000; 5 children (2 boys and 3 girls; median age, 6 years; range, 6 to 15 years) of a total of 21 (10 boys and 11 girls; median age, 13 years; range, 2 to 19 years) children undergoing kidney transplantation had a posttransplant lymphocele. The clinical course, renal function, and ultrasonographic appearance of the transplanted kidney of all children were observed in a prospective manner.
Results:
The lymphoceles became obvious between day 13 and 48 (median, 20 days) posttransplantation. Lymphocele size ranged from 2.0 x 3.0 cm to 11.0 x 15.0 cm. They were localized at any site (superior, inferior, lateral, medial, and dorsal) around the transplanted kidney. Four patients had a significant decrease of renal function, in 2 children mild urinary tract obstruction occurred, and 1 patient suffered from considerable abdominal pain. Diagnosis was established by ultrasound scan in all cases. All patients were treated by laparoscopic fenestration of the lymphocele immediately after diagnosis, except 1 patient, in whom fenestration was not done until 10 months later. Operating time ranged from 45 to 90 minutes (median, 62 minutes). No intraoperative or postoperative complication occurred. Renal function, urinary tract obstruction, and pain recovered soon after operation in all patients. After 3 to 10 months (median, 8 months) postoperatively, no relapse has been observed.
Conclusions:
Our data emphasize laparoscopic fenestration as the treatment of choice for children with posttransplant lymphoceles, because it is safe, effective, and technically easy to perform. If done early after diagnosis, renal function will recover immediately.
