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Qureshi SS, Rent EG, Bhagat M, Dsouza P, Kembhavi S, Vora T, Prasad M, Chinnaswamy G, Ramadwar M, Laskar S, Khanna N, Shah S, Talole S. Chyle leak following surgery for abdominal neuroblastoma. J Pediatr Surg 2016; 51:1557-60. [PMID: 26656616 DOI: 10.1016/j.jpedsurg.2015.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/31/2015] [Accepted: 11/01/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence and optimal management of postoperative chylous leak of neuroblastoma is inadequately documented. We analyzed the risk factors, management, and the implication of chyle leak following surgery for abdominal neuroblastoma. METHODS One hundred sixty patients who underwent surgery for abdominal neuroblastoma between September 2004 and August 2014 were evaluated. To find the oncological implication we evaluated the delay in starting further treatment, local control, event free and overall survival. RESULTS Chyle leak was the most common complication (20%). The median measure of leakage was 100ml/day and it persisted for a median of 12days. All patients were managed conservatively except one who needed exploration for wound dehiscence. Number of lymph nodes resected was the only factor associated with the risk of chyle leaks (p=0.013). Adjuvant chemotherapy was not delayed in any patient because of chyle leaks per se and the local control, event free and overall survival were not different for patients with and without chyle leak. CONCLUSION Chylous leakage is a common postoperative complication of abdominal neuroblastoma, predisposed by the number of lymph nodes resected. It responds to conservative management and does not compromise further the oncological treatment and outcome hence; it should not be a deterrent to complete surgery.
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Affiliation(s)
- Sajid S Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Bombay, India.
| | - Eugene G Rent
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Bombay, India
| | - Monica Bhagat
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Bombay, India
| | | | - Seema Kembhavi
- Department of Radiology, Tata Memorial Centre, Bombay, India
| | - Tushar Vora
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Maya Prasad
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Bombay, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Centre, Bombay, India
| | - Sanjay Talole
- Department of Biostatistics, Tata Memorial Centre, Bombay, India
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Baek SJ, Kim SH, Kwak JM, Kim J. Incidence and risk factors of chylous ascites after colorectal cancer surgery. Am J Surg 2013; 206:555-9. [PMID: 23856087 DOI: 10.1016/j.amjsurg.2013.01.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 12/23/2012] [Accepted: 01/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to identify possible risk factors associated with chylous ascites after colorectal cancer surgery. METHODS Patients who underwent colorectal cancer resection were enrolled in this study. Data were compared between patients who developed chylous ascites and those who did not. RESULTS Chylous ascites was detected in 48 (6.6%) patients. There were significant differences between the groups with and without chylous ascites in terms of age (65.6 vs 61.6 years, P = .017), operator (5.0% vs 15.5%, P < .001), operative procedure based on tumor location (P = .041), operative time (206.0 vs 229.8 minutes, P = .045), and blood loss (78.1 vs 219.7 mL, P = .036). After subgroup analysis for right-sided colectomy and low anterior resection to compensate for the effects of the operative procedure, the differences in the operative time and blood loss were not significant. In most patients, chylous ascites was resolved with conservative management. CONCLUSIONS Chylous ascites developed significantly more frequently in patients who underwent right-sided colectomy and in elderly patients. In addition, the incidence was also dependent on the operator. Conservative treatment was effective in most patients.
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Affiliation(s)
- Se-Jin Baek
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul 136-705, Korea
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Kuboki S, Shimizu H, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, Furukawa K, Miyazaki M. Chylous ascites after hepatopancreatobiliary surgery. Br J Surg 2013; 100:522-7. [DOI: 10.1002/bjs.9013] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Postoperative chylous ascites following abdominal surgery is uncommon. It potentially induces malnutrition and immunodeficiency, contributing to increased mortality. In the field of hepatopancreatobiliary (HPB) surgery, no large studies have been conducted that focused on postoperative chylous ascites. The aim of this study was to determine the incidence, risk factors and management of chylous ascites following HPB surgery, with particular emphasis on pancreatic resection.
Methods
Consecutive patients who had HPB surgery between 2000 and 2011 at a single institution were reviewed retrospectively. Chyle leak was defined as 100 ml/day or more of milky, amylase-free peritoneal fluid with a triglyceride concentration of 110 mg/dl or above. Risk factors for chylous ascites associated with pancreatic resection and the clinical efficacy of octreotide in treating chylous ascites were evaluated.
Results
Of 2002 consecutive patients who underwent HPB surgery during the study period, 21 (1·0 per cent) developed chylous ascites. Chylous ascites occurred relatively frequently in patients who had a pancreatic resection, such as pancreaticoduodenectomy (3·3 per cent) or distal pancreatectomy (3·8 per cent). Multivariable analysis revealed that manipulation of the para-aortic area (P < 0·001), retroperitoneal invasion (P = 0·031) and early enteral feeding after operation (P < 0·001) were independent risk factors for chylous ascites following pancreatic resection. Octreotide treatment decreased drainage output of chylous ascites on day 1 after initiation of treatment (P = 0·002).
Conclusion
Chylous ascites is a rare complication following HPB surgery. It is more common after pancreatic resection. Treatment with octreotide combined with total parenteral nutrition is recommended.
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Affiliation(s)
- S Kuboki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - H Shimizu
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - H Yoshidome
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - M Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - A Kato
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - H Yoshitomi
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - K Furukawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | - M Miyazaki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
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Barakat HM, Shahin Y, McCollum P. Chylous ascites complicating elective abdominal aortic aneurysm repair: case report and review of treatment options. Vasc Endovascular Surg 2012; 46:682-5. [PMID: 22903333 DOI: 10.1177/1538574412457083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Chylous ascitis is a rare complication of abdominal aortic aneurysm (AAA) surgery with only 38 cases reported since the early 70s. Due to their anatomical relation with the abdominal aorta, cisterna chyli injury is more common following open AAA repairs when compared to other surgeries; 81% of all postsurgical chylous ascites reported. CASE PRESENTATION We present a case of severe chylous ascitis following elective AAA repair in a 76-year-old caucasian male who gradually developed abdominal distension following discharge. A conservative approach was followed by a peritoneovenous shunt insertion, but this had no clinical benefit. The site of chyle leak was identified and ligated at relaparatomy to eventually resolve his ascitis. CONCLUSION Many reports in literature demonstrate successful conservative measures and highlight the importance of nutritional status in the course of persistent postoperative chylous ascitis. In our experience, complete resolution only came after relaparatomy and repair of leaking lymphatics.
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Affiliation(s)
- Hashem M Barakat
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull, United Kingdom.
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5
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Roche-Nagle G, Walsh S, Barry MC. Chylous ascites following abdominal aortic aneurysm repair. Vascular 2009; 17:100-2. [PMID: 19426641 DOI: 10.2310/6670.2008.00059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A woman aged 75 years developed chylous ascites day 5 after emergency abdominal aortic aneurysm repair. She was still on artificial ventilation at the time of diagnosis. The first symptoms were high ventilation pressure, an elevated diaphragm, and abdominal distention. The patient was treated conservatively with drainage and total parenteral nutrition and given tube feeding without long-chain triglycerides. Unfortunately, the patient died of sepsis on day 25. Chylous ascites is an unusual complication of retroperitoneal surgery. Abdominal paracentesis is a simple means to confirm the diagnosis. Initial treatment consists of draining the chylus and a medium-chain triglyceride diet or total parenteral nutrition. When this fails, more invasive treatment is required, consisting of direct lymphatic repair or peritoneovenous shunting. In mechanically ventilated patients, gradually progressive symptoms of abdominal hypertension after surgery in the retroperitoneal space should arouse suspicion of this complication.
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Yeo MS, Tan LG, Chang SK. Postoperative chylous ascites: An institutional experience over two years. SURGICAL PRACTICE 2008. [DOI: 10.1111/j.1744-1633.2008.00415.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Assumpcao L, Cameron JL, Wolfgang CL, Edil B, Choti MA, Herman JM, Geschwind JF, Hong K, Georgiades C, Schulick RD, Pawlik TM. Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 2008; 12:1915-23. [PMID: 18685899 DOI: 10.1007/s11605-008-0619-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/15/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND No data on incidence, management, or natural history of chyle leaks following pancreatic resection have been published. We sought to identify possible risk factors associated with chyle leaks following pancreatic resection, as well as determine the natural history of this rare complication. METHODS Between 1993 and 2008, 3,532 patients underwent pancreatic resection at a single institution. Data on demographics, operative details, primary tumor status, and chyle leak were collected. To identify risk factors associated with chyle leak, a matched 3:1 paired analysis was performed. RESULTS Of 3,532 patients undergoing pancreatic resection, 47 (1.3%) developed a chyle leak (n = 34, contained chyle leak versus n = 13, diffuse chylous ascites). Chyle leak was identified at median 5 days following surgery. Median drain triglyceride levels were 592 ng/dl. After matching on tumor size, disease etiology, and resection type, the number of lymph nodes harvested and history of concomitant vascular resection predicted higher risk of chyle leak (both P < 0.05). Total parenteral nutrition (TPN) was required in more patients with chylous ascites (92.3%) than those with chyle leaks (44.1%) (P = 0.003). The median time to resolution was shorter for contained chyle leaks (13 days) versus chylous ascites (36 days) (P < 0.001). Patients with chylous ascites tended to have shorter overall survival (3-year, 18.8%) versus patients with no chyle leak (3-year, 46.9%) (P = 0.12). In contrast, patients with a contained chyle leak had a similar survival as patients with no chyle leak (3-year, 53.4% versus 46.9%, respectively) (P = 0.32). CONCLUSION Chyle leak was a rare (1.3%) complication following pancreatic resection that was associated with number of lymph nodes harvested and concomitant vascular resection. In general, chyle leaks were successfully managed with TPN with no adverse impact on outcome. Patients with chylous ascites, however, had a more protracted clinical course and tended to have a worse long-term survival.
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Affiliation(s)
- Lia Assumpcao
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Olthof E, Blankensteijn JD, Akkersdijk GJ. Chyloperitoneum Following Abdominal Aortic Surgery. Vascular 2008; 16:258-62. [DOI: 10.2310/6670.2008.00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chyloperitoneum is an uncommon but serious complication following abdominal aortic surgery. As there seems to be no uniformity concerning the treatment, we performed a literature search to evaluate the best treatment results. All Medline-cited articles on chyloperitoneum after abdominal aortic surgery were assessed and analyzed. Thirty-eight cases of chyloperitoneum following abdominal aortic surgery were found. Patients developed symptoms after a median of 16 days (range 2–120 days) and were asymptomatic after 68 days (mean, range 27–93 years). All patients underwent diagnostic paracentesis, which confirmed the diagnosis. In 26 cases (68%), paracentesis was part of the treatment. The use of diuretics (24%) as therapeutic value was abandoned. Total parenteral nutrition, used in 21 patients (55%), provides the possibility of an extended period of oral starvation that reduces the lymphatic flow from the leaking duct. Medium-chain triglyceride, used in 28 cases (76%), is generally accepted as reducing lymphatic flow. When all conservative measures fail, surgical exploration is indicated. Two surgical interventions were mentioned: placing a peritoneovenous shunt or transfixing the damaged lymph vessel; both were described with different outcomes. This review supports conservative treatment of chyloperitoneum following abdominal aortic surgery.
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Affiliation(s)
- Emilie Olthof
- *Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands; †Department of Vascular Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Jan D. Blankensteijn
- *Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands; †Department of Vascular Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - George J.M. Akkersdijk
- *Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands; †Department of Vascular Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
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9
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Su IC, Chen CM. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16 Suppl 3:332-7. [PMID: 17273839 PMCID: PMC2148082 DOI: 10.1007/s00586-007-0305-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 10/25/2006] [Accepted: 12/19/2006] [Indexed: 02/07/2023]
Abstract
Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.
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Affiliation(s)
- I-Chang Su
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No 7. Chung San South Road, 112 Taipei, Taiwan
| | - Chang-Mu Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, No 7. Chung San South Road, 112 Taipei, Taiwan
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Caumartin Y, Pouliot F, Sabbagh R, Dujardin T. Chylous ascites as a complication of laparoscopic donor nephrectomy. Transpl Int 2006; 18:1378-81. [PMID: 16297058 DOI: 10.1111/j.1432-2277.2005.00219.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Laparoscopic living donor nephrectomy (LLDN) is a minimally invasive technique for kidney procurement and was developed with the hope of reducing the disincentives associated with live renal donation. Compared with open donor nephrectomy (ODN), this alternative has many advantages including less postoperative pain and earlier return to work. Unfortunately, these benefits are sometimes negated by postoperative complications. Among these, chylous ascites (CA) is a rare but serious problem that is usually managed conservatively. We report the case of a living donor who developed CA refractory to initial conservative management and surgical treatment. We also discuss the role of surgery in the treatment of CA following LLDN.
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Affiliation(s)
- Yves Caumartin
- Service d'Urologie, Centre Hospitalier Universitaire de Québec, pavillon Hôtel-Dieu de Québec, Université Laval, Québec, Canada
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11
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Abstract
Chylous ascites is a rare and challenging clinical condition that occurs as a result of disruption of the abdominal lymphatics. We include a review of the literature describing the etiology, diagnosis, and therapy of chylous ascites.
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Affiliation(s)
- Tony Almakdisi
- Temple University/Conemaugh Memorial Hospital, Department of Medicine, Johnstown, Pennsylvania 15905, USA.
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12
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Sledzianowski JF, Suc B, Ferron G, Fourtanier G. [Reoperation for refractory postoperative chylous ascites: value of peritoneovenous shunt combined with closure of lympho-peritoneal fistula]. ANNALES DE CHIRURGIE 2002; 127:706-10. [PMID: 12658831 DOI: 10.1016/s0003-3944(02)00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postoperative chylous ascites is a rare but serious complication resulting in denutrition, lymphopenia and infection. The first-intent treatment is usually conservative. We report a case of chylous ascites after retroperitoneal lymphadenectomy for testicular cancer, persisting despite conservative treatment then successfully treated by lymphostasis combined with peritoneovenous shunt. In case of high-output postoperative chylous ascites in low-risk patients with presumed localization of fistula, reoperation is indicated for lymphostasis. We advise to associate a peritoneovenous shunt in case of incomplete closure of the lymphoperitoneal fistula to avoid the morbidity of prolonged ascites.
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Affiliation(s)
- J F Sledzianowski
- Service de chirurgie digestive, hôpital Rangueil, 1, avenue J.-Poulhès, 31043 Toulouse, France
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13
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Affiliation(s)
- Andrés Cárdenas
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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14
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Shafizadeh SF, Daily PP, Baliga P, Rogers J, Baillie GM, Rajagopolan PR, Chavin KD. Chylous ascites secondary to laparoscopic donor nephrectomy. Urology 2002; 60:345. [PMID: 12137847 DOI: 10.1016/s0090-4295(02)01743-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Live donor renal transplantation offers many significant advantages over cadaveric donor transplantation. Yet living donation continues to be underused, accounting for less than 30% of all donor renal transplants. In an attempt to remove the disincentives to live donation, Ratner et al. developed laparoscopic donor nephrectomy (LDN). LDN is gaining acceptance in the transplant community. The overriding concern must always be the safety and welfare of the donor. To this end, potential complications of LDN must be identified and discussed. We present a patient who developed the complication of chylous ascites from LDN. To improve the laparoscopic technique further, a discussion of its successes and complications needs to be encouraged. To this end, we present chylous ascites as a potential complication after LDN. We also offer suggestions to minimize the likelihood of this complication.
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Affiliation(s)
- Stephen F Shafizadeh
- Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Abstract
PURPOSE Postoperative chylous ascites is a rare complication of retroperitoneal and mediastinal surgery that represents a difficult management problem due to the serious mechanical, nutritional and immunological consequences of the constant loss of protein and lymphocytes. We reviewed the topic of postoperative chylous ascites with special emphasis on the relevant diagnostic and imaging modalities. We propose a novel management algorithm. MATERIALS AND METHODS We performed a MEDLINE search of the literature on chylous ascites using chyloperitoneum as the subject heading and chylous ascites as an additional key word. The search yielded 651 articles. We focused on 102 series, collective reviews and mainly case reports related to the issue of postoperative chylous ascites. RESULTS We propose a novel algorithm based on a step-up approach aimed at promoting decreased lymph production and flow as well as maintaining nutritional balance. The management algorithm integrates repeat palliative paracentesis, dietary measures, total parenteral nutrition therapy, peritoneovenous shunting and surgical closure of the lymphoperitoneal fistula. Due to the remarkable effectiveness of somatostatin therapy for the closure of lymphatic fistula somatostatin therapy should be attempted with or without total parenteral nutrition early in the course of treatment of chylous ascites before any invasive steps are taken. CONCLUSIONS Various management modalities may be used successfully to treat chylous ascites. Therefore, treatment should be individualized and adjusted to the severity of lymphatic leakage and its consequences. The outcome mostly depends on the underlying pathological condition. Thus, in the absence of malignant or congenital underlying pathology the prognosis in cases of postoperative chylous ascites is good with the majority responding to conservative measures.
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Affiliation(s)
- Ilan Leibovitch
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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