[Preventive treatment of lymphoceles after enlarged lymphadeno-colpohysterectomy: non-reperitonization with epiplooplasty]. / Un traitement préventif des lymphocèles après lymphadéno-colpo-hystérectomie élargie (L.C.H.E.): la non repéritonisation avec épiplooplastie.

Pelvic lymphadenectomy for genital cancer can lead to numerous complications, particularly lymphoceles. Two types of drainage were compared in a series of 86 patients treated by enlarged lymphadeno-colpohysterectomy. In the first group (n = 66), hermetic peritonization with aspiration drainage was performed and in the second group (n = 20), non-peritonization combined with omentoplasty was practiced. Lymphoceles developed in 23% of patients in group I, requiring 7.7% of recovery operations (5 cases). Lymphoceles did not occur in group 2. Qualities of reabsorption of peritoneum and omentum are discussed. Their combined use to avoid lymphocele complications is of benefit, particularly in patients receiving preoperative pelvic radiotherapy.

Anticoagulants and the formation of lymphocysts after pelvic lymphadenectomy in gynecologic and oncologic operations.

The incidence of lymphocysts was compared in two groups of patients treated by simple or radical hysterectomy including pelvic lymphadenectomy for carcinoma of the cervix and endometrium. Promoting factors for the formation of lymphocysts and the relation with thrombosis and prophylaxis are discussed.

Prevention of lymphocele formation following renal allotransplantation.

Lymphocele formation is a recognized complication of renal allotransplantation that can jeopardize the graft and cause major morbidity for the allograft recipient. Previously, emphasis has been placed on treatment as opposed to prevention. We attempted to prevent lymphocele formation by adopting 2 techniques in performing the renal transplantation: 1) we limited the area of dissection in the recipient to that necessary to obtain vessel control of the segment of iliac vessel that was to be used for the vascular anastomosis (to decrease the number of lymphatics that were divided or destroyed) and 2) we practiced lymphostasis as meticulously as we did hemostasis. We did not attempt to ligate any lymphatics in the hilus of the kidney. Using these techniques we have performed 198 consecutive renal allografts without the development of an identifiable lymphocele. The limitation of the area of vessel dissection has not increased either the rate of major vascular complications (2 per cent) or the development of major pulmonary embolism (0.5 per cent) after transplantation. We conclude that extensive dissection of the iliac vessels is not necessary to prevent major vascular complications or pulmonary emboli after renal transplantation, that careful lymphostasis in the allograft recipient will prevent the development of a lymphocele and, therefore, that the lymph fluid in a lymphocele is derived primarily from the allograft recipient and not from the allograft itself.

Prevention of lymphoceles following renal transplantation.

Lymphoceles occur follow 1.2 to 18.1% of renal transplants. Of 543 kidney transplants performed at the University of Minnesota, lymphoceles occured in three (an incidence of 0.6%). These three patients are described. We believe lymphoceles can be prevented by ligation of all lymphatic channels around the iliac artery and vein as these structures are dissected. Also the lymphatics of the donor kidney should be ligated before division. Lymphoceles are best treated by drainage into the peritoneal cavity after excision of as much of the cyst wall as possible.