Chylous Ascites Management After Pancreatic Surgery

Abstract

Owing to postoperative CA rarity, there is no consensus in treatment. Early on, CT should be attempted in all patients with CA. BPLAG is a safe and efficient procedure that should be discussed earlier in the step-up therapeutic management.

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

“…Refractory PLL can significantly affect postoperative recovery time, wound healing, and quality of life. High-output PLL increases morbidity and mortality among patients due to lymphocytopenia, protein loss, fat loss, malnutrition, respiratory distress, and immune suppression [1,[3][4][5]. For the past three decades, conservative and surgical treatments have defined the standard for managing PLL.…”

“…Surgical management comprises different and at least in parts non-standardized approaches such as lymph duct ligation, shunt implantation, sclerotherapy with doxycycline or thrombin, plastic surgery, and wound vacuum therapy [6,7]. Depending on the type, degree and location of PLL, both conservative and surgical management can be challenging to perform, time-consuming and expensive as well as clinically ineffective, whereby surgery-related complication and mortality rates of up to 38 % and 25 %, respectively, have been described [1,3,4,6,[8][9][10][11][12][13]. Conventional lymphangiography (CL), a radiological examination performed under X-ray imaging after contrast material injection, has emerged as an alternative to the aforementioned treatments.…”

Therapeutic Intranodal Lymphangiography for Refractory Chylous Ascites Complicating Acute Necrotic Pancreatitis

“…The treatment of chylous ascites is usually conservative, consisting of TPN or a MCT-rich diet, lowering the flow in the intestinal lymphatic system [3]. Early enteral nutrition, on the other hand, increases the risk of chylous ascites [12,13]. If conservative management fails, bipedal [13] or intranodal [2] lymphangiography should be attempted.…”

“…Early enteral nutrition, on the other hand, increases the risk of chylous ascites [12,13]. If conservative management fails, bipedal [13] or intranodal [2] lymphangiography should be attempted. Potential complications related to the intralymphatic injection of ethiodized oil are rare and include paradoxical cerebral embolization and lung emboli [14].…”

“…Intranodal lymphangiography with use of Lipiodol® has never previously been reported as a therapeutic option in post-pancreatitis chylous ascites, although it has been used as a treatment in other causes of refractory chyle leakage, such as pancreatic surgery, as reported in the study of Tabchouri et al [13]. In this retrospective analysis dealing with postoperative chylous ascites following pancreatic surgery, 5 out of 15 patients required additional bipedal Lipiodol-based lymphangiography after failed conservative management; no risk factors for failure of conservative management were identified [13]. In a larger study, including patients with both refractory chylothorax and chylous ascites, lymphangiography led to complete occlusion of lymph leaks of various origins in 70.3% of cases (96.8% of J Gastrointestin Liver Dis, June 2018 Vol.…”