Retroperitoneoscopic lymphatic disconnection for non-filarial chyluria in Vietnamese adults: a case series.

Introduction: Retroperitoneal laparoscopic surgery is a widely applied technique in the management of renal, adrenal, ureteral, and retroperitoneal lymphatic disorders. A representative condition is chyluria, a rare disease caused by a lymphatic-urinary fistula, most commonly involving the ureter and renal pelvis. The retroperitoneal approach provides direct access to the affected structures while minimizing intra-abdominal manipulation, thereby reducing the risks of bowel adhesions and visceral injury. This technique enables ligation, excision, or suturing of abnormal lymphatic vessels, potentially reducing surgical morbidity and facilitating postoperative recovery. However, meticulous dissection at the renal hilum is required, as lymphatic ligation in this area carries a potential risk of vascular injury. In this study, we report our experience with retroperitoneoscopic lymphatic disconnection for non-filarial chyluria in six patients treated at a tertiary referral center, focusing on surgical technique, perioperative outcomes, and long-term follow-up. Methods: This retrospective case series included six patients diagnosed with non-filarial chyluria who underwent retroperitoneoscopic lymphatic disconnection between January 2022 and January 2025. All patients had clinical and radiological confirmation of chyluria. Retroperitoneoscopic lymphatic disconnection was performed after preoperative insertion of a JJ stent. Data on demographics, operative details, complications, and postoperative outcomes were analyzed. Results: The mean age was 68.8 ± 15.6 years (range 41-87). Four patients were female. All presented with milky or pinkish-white urine. Left kidney involvement predominated (4/6). Mean operative time was 122.9 minutes (range 90-180), mean blood loss was 116.7 mL, and mean hospital stay was 9.2 days (range 7-13). Two patients sustained minor renal vein injuries that were repaired laparoscopically. One patient required reoperation due to persistent chyluria; one developed a trocar-site infection; and one developed a postoperative perinephric abscess that resolved with ultrasound-guided drainage. At a median follow-up of 24 months, no recurrence was observed, with clear urine and negative chyle tests. Conclusion: Retroperitoneoscopic lymphatic disconnection appears to be a feasible treatment option for selected patients with refractory non-filarial chyluria. However, the procedure is technically demanding and requires careful hilar dissection to minimize vascular complications.