Review
Treatment options for chylous ascites after major abdominal surgery: a systematic review

Presented at the 35th annual meeting of the German Pancreas Club, January 22–24, 2015, Rostock, Germany
https://doi.org/10.1016/j.amjsurg.2015.04.012Get rights and content

Highlights

  • Postoperative chylous ascites represents a relevant economic problem, especially in oncologic surgery.

  • Extensive lymphadenectomies and lymphatic tissue dissections increase the risk.

  • Conservative treatment is highly effective in resolving chylous ascites.

Abstract

Background

Chylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay.

Data sources

A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement. The search for the MeSH terms “chylous ascites” and/or “lymphatic fistula” retrieved a total of 2,348 articles, of which 36 full-text articles were reviewed by 2 independent investigators.

Results

Chylous ascites is described with an incidence of up to 11%, especially after pancreatic surgery. The incidence is increasing with the number of lymph nodes harvested. In patients treated with total parenteral nutrition, conservative treatment is demonstrated to be effective in up to 100% of cases.

Conclusions

The extent of abdominal surgery mainly predicts the risk of chylous ascites. Conservative treatment has been shown to be effective in almost all cases and is the treatment of choice.

Section snippets

Search strategy

A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement for reporting systematic reviews and meta-analyses.2 The search terms used were “chylous ascites” and/or “lymphatic fistula.” The results were examined by 2 independent investigators (M.W. and J.G.D.) for further selection. Additionally, reference lists were hand searched for relevant literature.

Inclusion criteria

After screening and examination of the articles obtained, the articles were included for

Results

The search for the MeSH terms “chylous ascites” and/or “lymphatic fistula” retrieved a total of 2,348 articles; all titles were screened for relevance. After removal of duplicates a total of 2,341 articles remained. Subsequently, 1,440 articles were excluded because they were either not published in English or published before January 1, 1990. Nine hundred one publications were eligible for analysis after application of these exclusion criteria. Of these 901 publications, 369 case reports, 41

Comments

Postoperative chylous ascites is a common phenomenon in abdominal surgery that causes significant prolongation of hospital length of stay and thus increases healthcare costs. However, the evidence on this issue is limited. Chylous ascites is commonly believed to be the result of direct trauma to the cisterna chyli or one of its branches with subsequent lymphatic leakage into the peritoneal cavity. Chylous ascites may cause significant morbidity including malnutrition, dehydration,

Conclusions

In conclusion, postoperative chylous ascites is not a frequent but an important clinical issue, especially in pancreatic surgery. It is mainly predicted by the extent of lymphadenectomy and lymphatic tissue dissection. In the early postoperative course, fat-containing enteral feeding should be avoided before the 4th postoperative day. In cases with increased risk of chylous ascites, an intraoperative milk test may be considered. Once diagnosed, TPN provides a high efficacy in resolving chylous

Acknowledgment

The authors are pleased to acknowledge Nandini Ganesh, M.D., for proofreading this article.

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    There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

    The authors declare no conflicts of interest.

    1

    Maximilian Weniger and Jan G. D'Haese contributed equally to this work.

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