Surgical disconnection of lymphorenal communication for chyluria: a 15-year experience
S V Punekar1, A R Kelkar, A R Prem
1Department of Urology, Seth G.S. Medical College, Parel, Mumbai, India.
Objective:
To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria.
Patients And Methods:
Seventy-eight patients (40 men and 38 women, age 22-58 years) with severe chyluria of variable duration (5 months to 14 years), underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules, lymphangiography to delineate the side, site and extent of lymphorenal communication, and cystoscopy to decide the side to be operated. The areolar tissue containing dilated lymphatics travelling to the kidney in the perirenal and hilar region was dissected and divided between ligatures, thus stripping these structures completely; only one side was operated at a time.
Results:
All 78 patients were available for a minimum follow-up of 1 year, with the longest follow-up 15 years. Lymphangiography showed unilateral communication in 52 (66%) and bilateral in 26 (34%). If the patient was given a high-fat meal before surgery, the intra-operative visualization of the lymphatics was improved. With unilateral surgery, clearance was achieved in 74 (94%) immediately, with final success in 69 (88%) patients. Of the 26 (34%) patients with bilateral lesions, nine (12%) required bilateral surgery, giving a clearance rate of 97%. In two cases of failure, repeat surgery was successful in one; thus the overall success rate was 98%.
Conclusion:
Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Bilateral lymphorenal communication seen on lymphangiography does not always warrant bilateral surgery.
