Incidence, Diagnosis, and Treatment of Chylous Leakage After Laparoscopic Live Donor Nephrectomy

Abstract

CL is a potentially insidious and perhaps misdiagnosed complication after LLDN. It occurs in nearly 4% of LLDN and it seems to be uniquely associated to left-sided kidney recovery because of distinctive lymphatics distribution around the periaortic area of dissection. Conservative therapy is effective in most donors and should be initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory CL before the arising of malnutrition and/or relevant immunodeficiency.

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

“…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).…”

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“…Meticulous and extensive clipping remains the safest way of securing lymphatic channels along the dissection area. 10 It has been shown that bipolar cautery can effectively ligate and control lymph leakage. Using bipolar cauterizing, we have not seen 1 case of lymph leakage after more than 1500 laparoscopic donor nephrectomy.…”

“…9 Boggi and associates report 8 cases of 208 LLDN successfully treated with conservative measures, providing further insight into both anatomicbasis and available therapeutic options. 10 Breda and associates 8 described 2 cases of chylous ascites, both patients were treated with low-fat, medium-chain triglyceride (MCT) diet. The chyle leak resolved after 2 weeks of conservative management, but the dietary regimen modifications were prolonged for 6 months to prevent recurrence.…”

“…10,12 Approximately 60% of CL tend to resolve with supportive measures, especially if they are caused by tiny leaking lymphatics. 12 Withdrawing the long-chain triglycerides quota from the diet in favor of MCT should help avoiding lymph overflow.…”

“…Instead, 1 patient was kept on a strict low-fat and high-protein dietary regimen along with MCT oil supplement and octreotide injections at a lower dosage (100 g/q 8 h). 10 A surgical approach is usually recommended if the lymphatic leak persists, despite 4 to 8 weeks of conservative treatment to avoid malnutrition and/or clinically relevant immunodeficiency. 15 To prevent CL, it is mandatory to spend some extra time trying to identify major lymphatics nearby renal vessels and the anterolateral surface of the aorta.…”