Electrocoagulation versus suture-ligation of lymphatics in kidney transplant recipient surgery

ABSTRACT

To compare electrocoagulation versus suture-ligation of the lymphatics in kidney transplant operation of the recipient in terms of operating time, cost effectiveness, drainage from renal bed and incidence of lymphocele. This prospective comparative study was conducted at the department of Urology and Kidney Transplantation, Hearts International Hospital Rawalpindi during a period of two and a half years [January 2003 to July 2005] by a single surgical team. All patients who underwent kidney transplant during this period and did not fall into exclusion criteria were included in the study. Ninety Cases of End-stage Renal Disease undergoing kidney transplant were randomly divided into two equal groups. Patients in the group A had their lymphatics electrocoagulated and divided in the preparation of external iliac vessels for allograft anastomoses, while the patients in group-B underwent suture-ligation and division of the lymphatics covering the external iliac vessels. The average operating time was reduced in group-A. Also, no suture material was used for this step. Over all anesthesia time was also less. There was no significant difference in the quantities of postoperative drainage from the wound. There was no incidence of lymphocele development in group-A [0%]. While one patient [2.2%] in group-B had a moderate lymphocele which was aspirated and there was no recurrence. Cut off point of the study was six months from the day of surgery. Electro-coagulation and division of lymphatics coursing over the external iliac vessels is an attractive procedure. It saves time, is cost-effective, the postoperative wound drainage is not a problem and the procedure is not associated with increased incidence of lymphocele