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Laparoscopic marsupialization of lymphocele after combined pancreas-kidney transplantation
H Waleczek1, M Buesing, W Kozuschek
1Surgical Clinic, Holy Ghost Hospital, Hagen, Germany.
Early definitive treatment of symptomatic posttransplant lymphoceles offers good results with fewer graft losses and reduced morbidity. If interventional therapy fails, laparoscopic internal marsupialization to the peritoneal cavity may be performed with excellent results and at low cost. In combined pancreas-kidney transplantation the transperitoneal laparoscopic access may be difficult due to adhesions caused by the intraabdominal positioning of the pancreatic graft and posttransplantation pancreatitis. Both posttransplantation lavage of the abdominal cavity as well as immunosuppression reduce formation of intraabdominal adhesions subsequent to combined pancreas-kidney transplantation. Thus, posttransplant lymphoceles may be treated safely even after combined kidney-pancreas transplantation.
Early definitive treatment of symptomatic posttransplant lymphoceles offers good results with fewer graft losses and reduced morbidity. If interventional therapy fails, laparoscopic internal marsupialization to the peritoneal cavity may be performed with excellent results and at low cost. In combined pancreas-kidney transplantation the transperitoneal laparoscopic access may be difficult due to adhesions caused by the intraabdominal positioning of the pancreatic graft and posttransplantation pancreatitis. Both posttransplantation lavage of the abdominal cavity as well as immunosuppression reduce formation of intraabdominal adhesions subsequent to combined pancreas-kidney transplantation. Thus, posttransplant lymphoceles may be treated safely even after combined kidney-pancreas transplantation.