Sathish Kumar G1, Haris C. H2, Vaibhav Vikas3, Jatin Soni4
BACKGROUND
Lymphorrhoea
is a frequent cause of peritransplant fluid collection seen postoperatively after renal transplantation. Most of the
lymph leaks resolve without complications within one to two weeks after surgery. Sometimes the leaks are exaggerated, last
longer and prevent removal of surgical drain. In addition to prolonging hospital stay, it may lead to loss of protein and fluids,
with resultant dehydration, nutritional deficiency and immunologic dysfunction. Persisting lymphorrhoea is the most important
cause of lymphocele formation. Surgical damage to lymphatics around iliac vessels of the recipient during bed preparation and
lym phatics of donor kidney during procurement or during bench surgery leave behind open lymphatic channels that keep leaking
for long periods after transplantation. A number of medical causes have also been identified that lead to lymphorrhoea.
MATERIALS AND METHODS
Only
live related donor cases were selected for our study. Two weeks after renal transplantation, the drain fluid was tested for
fluid urea, creatinine, sodium, potassium, total protein and albumin to rule out urine leak. A sample was sent for culture and
sensitivity to rule out infection. Patients with drain fluid 200 ml. at two weeks were randomized into two groups; one group
(study group 20 patients) underwent extra peritoneal povidone iodine instillation via the drain tube, which was clamped for
one hour; the other group (control group 19 patients) was managed conservatively by gradual pulling out the drain tube over
days. The end point for drain tube removal was less than 50 ml. drain output for two consecutive days. Subsequently patients
were discharged from hospital with monthly review that included Ultra Sound Scan of the graft with Doppler study.
RESULTS
7
patients in the study group and 7 patients in the control group had resolution of drain fluid by two and a half weeks. 2 patients
in the control group and 13 patients in the study group had resolution of drain fluid by 19 21 days (3 weeks). 9 patients in the
control group had a prolonged hospital stay of 3 8 weeks before drain tube could be removed. The total number of days of
hospital stay were 3.5 4 weeks in patients in the study group and 3.5 8 weeks in the control group. Time for normalization
of S. Creatinine (Mean SD) was 25.3 9.3 in the control group and 18.6 6.8 in the study group. 3 patients in the control
group developed symptomatic lymphocele during follow up, and none in the study group.
CONCLUSION
Though
this study is limited by the number of patients, results were significant, and in the absence of side effects, our study
shows that povidone iodine instillation (extraperitoneal perinephric) may prove to be a simple, safe and effective surgical tool
to limit post operative lymphorrhoea in renal transplant patients.
