Chylous ascites after hepatopancreatobiliary surgery

Abstract

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.

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

“…The definition of the minimum daily volume of chylous ascites varied from 100ml (12) to 600ml (16), but most authors define 200ml /24h as the lower limit (8,15,18). Laboratory findings typical for chylous ascites were amylase (12,15,16)-and bilirubin-poor (16), chylomicron-rich (16) drainage fluid with a triglyceride concentration >110 mg/dl (5,8,12,14,15) or >1.2 mmol/l (1, 27). Other authors used a minimum of 150 mg/dl (11) or 200 mg/dl (17) in triglycerides.…”

“…Incidence of chylous ascites ranged from 0.17% to 2% in gynecological pelvic surgery (3)(4)(5), 1.0% to 6.6% in colorectal surgery (6-8), 4.7% in hepatic surgery including liver transplantation (9), 3.8% to 5.1% in nephrectomy (10,11), and 1.0% to 11% in pancreatic surgery (1, [12][13][14][15][16][17][18][19]. The incidence of chylous ascites in patients with abdominal drainage after pancreatic surgery did not differ significantly from those patients without drainage (20).…”

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

“…Chyloperitoneum is more prevalent after extensive abdominal operation involving the retroperitoneum [8]. Patients undergoing pancreatic resection develop a chyle leak in 1.8% to 11% [9] of cases, possibly due to surgical disruption of the cisterna chyli or its major tributaries located at the same level as the pancreas [10] induced by extended lymphadenectomy or dissection of the retroperitoneum. Another explanation may be the obstruction or malignant infiltration of lymphatic channels [11] with subsequent development of a lymphatic fistula that communicates with the peritoneal cavity, which is unlikely in this patient.…”

“…Some investigators have performed anticoagulant therapy during and after stent placement to prevent it [1,3,6,9,15,19,20]. On the other side, anticoagulation can be responsible for bleeding along the percutaneous transhepatic route, hypersensitivity, and heparininduced thrombocytopenia.…”

Chylous ascites after resection of giant adrenocortical carcinoma

“…In cases in which TPN is contraindicated or when more than <200 mL is drained, nutrition with medium-chain triglycerides (MCTs) is recommended (2). Administration of octreotide, an analog of somatostatin, may shorten duration of hospitalization when used in conjunction with TPN or MCT nutrition, and should be considered in cases of severe PCA (7). In cases showing resistance to conservative treatment, interventional or surgical procedures may be necessary.…”