Περίληψη:
In our series of 1,900 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 complications.
A 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
classification.
Three 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 < 0.001) of which a significant number
were symptomatic (n = 7, 14%, P < 0.001) and required laparoscopic
fenestration. No significant difference was observed between the pain
score in either group. Mean pain scores were 3.4 versus 3.8 at 6 h, and
0.8 versus 1.1 at 6 days, respectively. No difference in analgesia
requirement, serum inflammatory markers and return to normal bowel
activity was observed between the groups.
This 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.
Συγγραφείς:
Stolzenburg, Jens-Uwe
Wasserscheid, Johanna
Rabenalt, Robert and
Do, Minh
Schwalenberg, Thilo
McNeill, Alan
Constantinides,
Costantinos
Kallidonis, Panagiotis
Ganzer, Roman
Liatsikos,
Evangelos
