ReviewTreatment options for chylous ascites after major abdominal surgery: a systematic review
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.