Comparison of two approaches to retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria.

BACKGROUND AND PURPOSE The retroperitoneoscopic renal pedicle lymphatic disconnection has been performed mainly via a renal adipose (RA) capsule approach. In this study, we reported a novel technique via extra-adipose (EA) capsule approach and compared the two approaches for intractable chyluria. PATIENTS AND METHODS From December 2002 to March 2008, retroperitoneoscopic renal pedicle lymphatic disconnection was performed on 41 patients with 23 EA and 18 RA. The stripping of hilar vessels and ureterolympholysis were performed in both approaches, while the mobilization of the kidney was only performed in RA. Comparisons of the two approaches were conducted, including mean operative time, intraoperative blood loss, postoperative bed rest, and hospital stay, as well as operative outcome. RESULTS Patients were treated successfully without major complications. EA showed the same advantages as RA in terms of intraoperative blood loss (54.9±19.3 mL vs 59.3±26.5 mL, P>0.05), postoperative hospital stay (6.6±1.0 d vs 7.2±0.9 d, P>0.05). Chyluria disappeared in all patients immediately after the operations. EA was significantly superior to RA in operative time (78.9±18.3 min vs 101.8±20.6 min, P<0.05) and the postoperative bed rest time (20.7±1.7 h vs 72.0±0.0 h, P<0.05). No recurrence or nephroptosis was diagnosed in any patient within the follow-up of 21 to 84 months. CONCLUSIONS Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is safe and efficacious. EA offers significantly shorter operative time and earlier return to postoperative ambulation.