Ventral hernia following lymphocele fenestration in a patient after renal transplantation – a case report and treatment strategy

Introduction : Lymphocele is a common finding after renal transplantation. The frequency of this complication is up to 38%; of these, only 10% need surgical treatment. Unfortunately, hernia may be observed as a consequence of a lymphocele or its treatment.

Aim : To show the need for a complex approach to patients who have undergone kidney transplantation and in whom lymphocele has occurred. The secondary goal is to draw attention to the lack of randomized clinical trials which could give an answer to what type of approach the surgeon should use.

Case report : A 59-year-old woman underwent renal transplantation in June 2006. After one month a large lymphocele occurred surrounding the transplanted kidney, impressing the vein of the graft. In ultrasound examination, postoperative hernia was found. In August 2006 fenestration of the lymphocele was performed by the open approach with simultaneous onlay technique for repair of the hernia using PP mesh. In September 2006 the patient was admitted to the hospital with symptoms of bowel obstruction. Laparoscopy revealed colic intussusceptions into the post-fenestration orifice, which were liberated during the procedure. Hernia repair using laparoscopic intraperitoneal onlay mesh (IPOM) technique with ePTFE mesh was performed. Mesh was placed with a 5 cm overlap, using Protack tacks in the “double-crown” technique.

Conclusions : The presented case highlights the complexity of problems of ventral hernias occurring in patients who have undergone lymphocele treatment after renal transplantation. The surgical management should differ in different groups of patients (with hernia, with lymphocele, with both problems). Whether the open or the laparoscopic approach was used for that operation should be taken into consideration.