Authors: JensUwe Stolzenburg Johanna Wasserscheid Robert Rabenalt Minh Do Thilo Schwalenberg Alan McNeill Costantinos Constantinides Panagiotis Kallidonis Roman Ganzer Evangelos Liatsikos
Publish Date: 2008/09/07
Volume: 26, Issue: 6, Pages: 581-
Abstract
In our series of 1900 endoscopic extraperitoneal radical prostatectomies EERPE the incidence of symptomatic lymphocele following simultaneous pelvic lymph node dissection PLND is between 3 and 14 depending on the extent of lymph node dissection We report the impact of bilateral peritoneal fenestration after completion of extraperitoneal prostatectomy and PLND on the incidence of lymphocele postoperative pain and complicationsA total of 100 consecutive patients undergoing EERPE and extended PLND were allocated into two groups In Group A n = 50 a 4–6 cm incision was performed bilaterally over the external iliac vessels down to the obturator fossa after completion of the main procedure In Group B n = 50 no peritoneal incisions were made The postoperative assessment protocol included a visual analogue pain scale administered three times daily for 6 days analgesia requirement and ultrasound examination on 4th and 8th days and 3 months postoperatively CRP and leucocyte counts were measured on 1st and 2nd postoperative days Complications were recorded according to our standard protocol using the Clavien classificationThree patients 6 in Group A were found to have lymphoceles none of which were symptomatic Significantly more patients in Group B developed a lymphocele n = 16 32 P 0001 of which a significant number were symptomatic n = 7 14 P 0001 and required laparoscopic fenestration No significant difference was observed between the pain score in either group Mean pain scores were 34 versus 38 at 6 h and 08 versus 11 at 6 days respectively No difference in analgesia requirement serum inflammatory markers and return to normal bowel activity was observed between the groupsThis study demonstrates that peritoneal fenestration significantly reduces the incidence of both symptomatic and asymptomatic lymphocele without an increase in postoperative morbidity As symptomatic lymphocele is one of the most common complications of extraperitoneal PLND requiring reintervention we recommend that peritoneal fenestration should be performed routinely after extraperitoneal radical prostatectomy and PLND
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