Effect of Multiple Peritoneal Fenestrations on Lymphatic Complications After Renal Transplant: A Prospective Randomized Study.

Objectives: Lymphatic complications are a common (up to 30%) surgical complication after renal transplant. Both lymphocele and lymphorrhea have been extensively studied, but solutions are still sought. We designed a prospective randomized study to determine the effect of multiple intraoperatively performed peritoneal fenestrations on lymphatic complications after renal transplant.

Materials and methods: Over an 18-month period, we randomized eligible recipients for living donor renal transplant into 2 groups: group 1 had small preventive peritoneal fenestrations (10 of 2 cm each) after graft implant, andgroup2hadnofenestrations. We examined lymphatic complications (primary outcome), age, male versus female distribution, hemodialysis duration, body mass index, operation time, acute rejection, delayed graft function, warm ischemia time, and hospital stay. We compared results with t tests or χ2 test/the Fisher exact test.

Results: The 2 groups (10 in group 1 and 14 in group 2) were comparable with respect to demographic and clinical parameters, including operation time, warm ischemia time, and cold ischemia time; however, duration of preoperative dialysis was significantly less in group 1 (12.3 ± 2.8 vs 21.0 ± 4.6 mo; P < .001). Lymphocele, lymphorrhea and overall lymphatic complications were not significantly different between the groups, except for postoperative drain output, which was lower in group 1 than in group 2. No intestinal obstruction, ascitic leak, or bowel injury was reported in group 1 or group 2. On univariate analysis, none of the studied factors significantly affected lymphatic complications.

Conclusions: Preventive peritoneal fenestrations are a safe, feasible, and effective way of minimizing lymphatic complications; however, more studies with larger sample sizes are required.