The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Arianeb Mehrabi - One of the best experts on this subject based on the ideXlab platform.
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prophylaxis of Lymphocele formation after kidney transplantation via peritoneal fenestration a systematic review
Transplant International, 2017Co-Authors: Andre L Mihaljevic, Mohammad Golriz, Patrick Heger, Sepehr Abbasi Dezfouli, Arianeb MehrabiAbstract:Summary Lymphocele formation after kidney transplantation is a frequent complication which causes pain, secondary graft loss, rehospitalizations and reoperations. Therefore, prophylaxis of Lymphocele formation is of utmost importance. To assess the effectiveness of peritoneal fenestration in renal transplantation to prevent Lymphocele development. A systematic literature search was conducted combined with hand-searches on Lymphocele prevention following renal transplantation using peritoneal fenestration. A qualitative and quantitative analysis of included trials was conducted. We identified three trials including 414 patients and 437 transplantations which studied peritoneal fenestration. Only one randomized controlled trial was identified. Critical appraisal uncovered a number of methodological flaws, predominantly in the nonrandomized studies. Most importantly endpoint definitions varied among trials, selection bias was high and interventions and follow-up were not standardized. Meta-analysis of the included trials showed a significant reduction of clinically symptomatic Lymphoceles (OR: 0.23, 95% CI: 0.09–0.64, P = 0.005) and overall postoperative fluid collections (OR: 0.49, 95% CI: 0.28–0.88, P = 0.02) without a significant increase in other surgical complications. Although peritoneal fenestration is a promising technique to reduce Lymphocele formation, only few studies have investigated this technique so far. Given the low methodological quality of included trials, more studies are necessary to evaluate the effectiveness and the risks and benefits of this technique.
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prevention and management of Lymphocele formation following kidney transplantation
Transplantation Reviews, 2017Co-Authors: Mohammad Golriz, Miriam Klauss, Martin Zeier, Arianeb MehrabiAbstract:Despite preventive methods, Lymphoceles frequently form following kidney transplantation (KTx), with an incidence of 0.6%-51%. Here, we summarize the current strategies for preventing and managing this complication, and describe the approach used in our department. Rapid diagnosis and early treatment of Lymphoceles through a well-defined approach can prevent or reduce the risk of organ loss. Diagnosis can be made by ultrasound, computed tomography, or magnetic resonance imaging and laparoscopic fenestration is the current therapy of choice when non-surgical methods fail. Preventive methods should be performed pre-, intra-, and post-operatively. A peritoneal fenestration at the end of KTx seems to be a reasonable method for preventing Lymphocele formation.
Farhang Rabbani - One of the best experts on this subject based on the ideXlab platform.
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predictors of symptomatic Lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection
International Journal of Urology, 2011Co-Authors: Geoffrey Gotto, Luis Herran Yunis, Bertrand Guillonneau, Karim Touijer, James A Eastham, Peter T Scardino, Farhang RabbaniAbstract:Objectives: Lymphocele is the most common complication of pelvic lymphadenectomy (PLND). We sought to determine predictors of symptomatic Lymphocele after radical prostatectomy (RP) and PLND, and in particular, to determine if the number of drains placed represents an independent predictor. Methods: Between January 1999 and June 2007, 4173 consecutive patients underwent bilateral PLND at the time of either open or laparoscopic RP. Lymphoceles were identified in patients undergoing imaging as a result of symptoms suspicious for Lymphocele, such as fever, abdominal pain or lower extremity swelling. Routine postoperative imaging was not carried out. Cox proportional hazards analysis was carried out using forced variable entry to obtain maximum likelihood estimates of the hazard ratios and 95% confidence intervals using the number of drains placed, number of nodes removed, RP approach and use of prophylactic low-molecular-weight heparin (LMWH) as predictors of symptomatic Lymphocele. Results: There were 164 patients (4%) with a symptomatic Lymphocele on follow up, with a median time to presentation of 19 days. The primary presenting complaints were fever in 47%, abdominal pain in 40%, lower extremity swelling in 37%, genital swelling in 25%, groin pain in 22%, abdominal swelling in 9%, and back and flank pain in 6% and 5%, respectively. Median Lymphocele diameter was 5 cm. Significant predictors of symptomatic Lymphocele on multivariate analysis included number of nodes removed and use of LMWH, but not number of drains placed. Conclusions: Use of prophylactic LMWH and a higher node count are predictive of a higher incidence of symptomatic Lymphocele after RP and PLND.
Maxim Itkin - One of the best experts on this subject based on the ideXlab platform.
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Sclerotherapy in the management of postoperative Lymphocele
Journal of Vascular and Interventional Radiology, 2010Co-Authors: Arie Mahrer, Parvati Ramchandani, Scott O. Trerotola, Richard D. Shlansky-goldberg, Maxim ItkinAbstract:Purpose To describe a single-center experience with sclerotherapy of postoperative Lymphocele and to determine the risk factors for failure of treatment. Materials and Methods From 1999 to 2007, 43 patients with postsurgical Lymphocele were treated with sclerotherapy with a combination of povidone iodine, alcohol, and doxycycline. The treatments were repeated at weekly intervals. The initial drainage volume of the Lymphocele, the location of the Lymphocele, the number of treatments, and the outcomes were retrospectively collected. Results In 38 patients, the Lymphocele was drained percutaneously, and in five patients, the treatment was initiated through an existing surgically placed drainage tube. Sclerotherapy was successful in 33 patients (77%). Complications that resulted in termination of the treatment were seen in five patients (12%): testicular pain, cellulitis, posttreatment increase in creatinine, acute renal tubular necrosis, and abdominal infection. In one of these patients the Lymphocele resolved after resolution of the infection. The average number of treatments was four (range, 1–14). There was no difference in success rate between superficial intraabdominal and soft-tissue Lymphoceles. There was a significant difference ( P Conclusions Sclerotherapy of postoperative Lymphoceles is an effective treatment. Success of sclerotherapy is directly related to the size of the Lymphocele cavity.
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the Lymphocele pill a case report of percutaneous imaging guided lymphatic ligation for the treatment of postsurgical lymph collections
Journal of Vascular and Interventional Radiology, 2008Co-Authors: Jennifer Shih, Scott O. Trerotola, Maxim ItkinAbstract:Lymphoceles occur after surgical interventions in areas with an extensive lymphatic network due to injury to the large lymphatic vessels. Recurrent Lymphoceles are treated percutaneously by using sclerotherapy, with surgery reserved for cases of failed sclerotherapy. In this case report, the authors describe a minimally invasive technique using lymphangiography and percutaneous imaging-guided lymphatic ligation of the feeding lymphatic vessel of a persistent Lymphocele refractory to the sclerotherapy.
Vipul R Patel - One of the best experts on this subject based on the ideXlab platform.
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can we predict who will need Lymphocele drainage following robot assisted laparoscopic prostatectomy ralp
Journal of Robotic Surgery, 2020Co-Authors: K Seetharam R Bhat, Fikret Onol, Travis Rogers, Hariharan P. Ganapathi, Marcio Moschovas, Shannon Roof, Vipul R PatelAbstract:Pelvic lymph node dissection (PLND) can cause Lymphoceles. Lymphocele formation following PLND can reach up to 60% and are symptomatic in 0.4 to 16% of patients. The aim of the study was to identify factors that are significantly associated with Lymphocele drainage. We retrospectively analysed all men that underwent RALP between April 2010 and November 2018 from our prospectively collected IRB approved database. All patients who developed Lymphoceles were grouped into two groups, the ones who were drained and those not drained. Chi-square test was used to perform univariate analysis for categorical variables and student’s t test for continuous variables. Odds ratio was calculated using logistic multiple regression analysis. A P value of less than 0.05 was considered significant. The size of the Lymphocele, the number of nodes retrieved, and BMI were significant factors that led to the drainage of Lymphocele. The patients with Lymphoceles larger than 10 cm had an odds ratio of 47.5 and those between 5 and 10 had an odds ratio of 10.7. The odds ratio of drainage in patients with BMI above 30 was 2.1. The odds of drainage were 8.8 when more than 10 nodes were taken. After PLND ultrasound could be effective in early identification of patients who could potentially need drainage. Early elective drainage should be offered to patients who have more than 10 lymph nodes removed with a Lymphocele size more than 10 cm in size and BMI above 30.
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Can we predict who will need Lymphocele drainage following robot assisted laparoscopic prostatectomy (RALP)?
Journal of Robotic Surgery, 2019Co-Authors: K. R. Seetharam Bhat, Fikret Onol, Travis Rogers, Hariharan P. Ganapathi, Marcio Moschovas, Shannon Roof, Vipul R PatelAbstract:Pelvic lymph node dissection (PLND) can cause Lymphoceles. Lymphocele formation following PLND can reach up to 60% and are symptomatic in 0.4 to 16% of patients. The aim of the study was to identify factors that are significantly associated with Lymphocele drainage. We retrospectively analysed all men that underwent RALP between April 2010 and November 2018 from our prospectively collected IRB approved database. All patients who developed Lymphoceles were grouped into two groups, the ones who were drained and those not drained. Chi-square test was used to perform univariate analysis for categorical variables and student’s t test for continuous variables. Odds ratio was calculated using logistic multiple regression analysis. A P value of less than 0.05 was considered significant. The size of the Lymphocele, the number of nodes retrieved, and BMI were significant factors that led to the drainage of Lymphocele. The patients with Lymphoceles larger than 10 cm had an odds ratio of 47.5 and those between 5 and 10 had an odds ratio of 10.7. The odds ratio of drainage in patients with BMI above 30 was 2.1. The odds of drainage were 8.8 when more than 10 nodes were taken. After PLND ultrasound could be effective in early identification of patients who could potentially need drainage. Early elective drainage should be offered to patients who have more than 10 lymph nodes removed with a Lymphocele size more than 10 cm in size and BMI above 30.
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incidence of Lymphoceles after robot assisted pelvic lymph node dissection
BJUI, 2011Co-Authors: Marcelo A Orvieto, Rafael F Coelho, Sanket Chauhan, Kenneth J Palmer, Bernardo Rocco, Vipul R PatelAbstract:Objective • To determine the incidence and predictive factors of Lymphocele formation in patients undergoing pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy (RARP). Patients and methods • Between April and December 2008, 76 patients underwent PLND during RARP for ≥cT2c, prostate-specific antigen level ≥10, Gleason score ≥7 prostate cancer. • All patients were prospectively followed up with pelvic computed tomography 6-12 weeks after the procedure. • All patients received s.c. heparin preoperatively and postoperatively. PLND was limited to zones 1 and 2 as defined by Studer. • Plasma-kinetic bipolar forceps were used for haemostasis during PLND. Results • At a mean follow-up of 10.8 weeks, 51% (39/76) of patients had developed a Lymphocele. Of these 39 Lymphoceles 32 (82%) were unilateral and seven (18%) were bilateral. • The mean (range) Lymphocele size was 4.3 × 3.2 (1.5-12.3) cm; 41% of Lymphoceles were 10 cm in diameter. Six of the 39 Lymphoceles (15.4%) were clinically symptomatic. The symptoms were as follows: pelvic pressure in five patients, abdominal distension with ileus in three patients, leg pain/weakness in one patient and costovertebral tenderness in one patient. Two Lymphoceles required intervention. • On the logistic regression model the presence of nodal metastases, tumour volume in the prostate specimen and extracapsular extension (ECE) were independent risk factors for the development of a Lymphocele. • There was no correlation between estimated blood loss, body mass index, pathological Gleason score or number nodes dissected and the presence of Lymphocele. Conclusions • The incidence of Lymphoceles was higher than anticipated given the believed protective effect of the transperitoneal approach against Lymphocele formation. • The risk of Lymphocele seemed to increase linearly with the presence of more extensive disease, particularly ECE and nodal involvement. • The benefit of PLND during RARP should be weighed against the elevated risk of Lymphocele formation and its potential complications.
Anna Fagotti - One of the best experts on this subject based on the ideXlab platform.
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a randomized study comparing the use of the ligaclip with bipolar energy to prevent Lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer
American Journal of Obstetrics and Gynecology, 2010Co-Authors: Valerio Gallotta, Francesco Fanfani, Cristiano Rossitto, Giuseppe Vizzielli, Antonia Carla Testa, Giovanni Scambia, Anna FagottiAbstract:Objective This prospective randomized pilot study compared the use of the Ligaclip (Ethicon Endo-Surgery, Cincinnati, OH) with bipolar coagulation in preventing Lymphoceles after laparoscopic pelvic lymphadenectomy for gynecologic cancer. Study Design Thirty patients with gynecologic malignancy, who had laparoscopic pelvic lymphadenectomy were randomly assigned for lymphadenectomy in 1 side of the pelvis using the Ligaclip, whereas, in the other side, the bipolar coagulation to seal lymphatic vessels was used. Results At ultrasound examination, we detected Lymphocele in 10 patients (33%). Lymphocele developed in 9 (30%) patients on the side where laparoscopic pelvic lymphadenectomy was perfomed using bipolar coagulation, and in 1 (3.3%) patient on the side where laparoscopic pelvic lymphadenectomy was performed using the Ligaclip. Univariate analysis revealed that the Ligaclip's use compared with electrocoagulation in the laparoscopic pelvic lymphadenectomy is an independent predictive factor for development of Lymphocele ( P = .006). Conclusion This study demonstrates that the use of the Ligaclip to close lymphatic vessels may reduce the incidence of Lymphoceles in patients undergoing laparoscopic pelvic lymphadenectomy.
