ABSTRACT
OBJECTIVES: Chyle leak or chylous ascites remains a rare complication after laparoscopic living-donor nephrectomy. Its cause and management have not been well elucidated in the literature. Thus, the aim of this study was to review the incidence of chyle leak/chylous ascites after laparoscopic living-donor nephrectomy in our institute and in the literature to propose a classification system with its associated treatment strategy. MATERILAS AND METHODS: In this retrospective review of laparoscopic living-donor nephrectomy patients from January 2005 to April 2016, we identified patients with chyle leak/chylous ascites along with the care performed. A proposed classification system based on our experience and literature is described. RESULTS: Chylous leak developed in 4 donors (2.25%). Of the 4 donors, 3 were treated nonoperatively with diet modification and subcutaneous octreotide injection. One patient required surgical intervention after not responding to second-line therapy with total parenteral nutrition. CONCLUSIONS: Chyle leak/chylous ascites after laparoscopic living-donor nephrectomy is rare, but a delayed diagnosis may lead to morbidity secondary to malnutrition and immunosuppression. Meticulous surgical dissection is essential to seal the lymphatic tubes during laparoscopic living-donor nephrectomy. The proposed classification system provides a practical and tailored guide to management based on the drainage volume of chyle leak and a guide to the earlier identification of refractory cases.
Subject(s)
Chylous Ascites/diagnosis , Chylous Ascites/therapy , Drainage , Kidney Transplantation/adverse effects , Laparoscopy/adverse effects , Living Donors , Nephrectomy/adverse effects , Octreotide/administration & dosage , Parenteral Nutrition, Total , Terminology as Topic , Adult , Chylous Ascites/classification , Chylous Ascites/epidemiology , Drainage/adverse effects , Female , Humans , Incidence , Injections, Subcutaneous , Kidney Transplantation/methods , Male , Middle Aged , Nephrectomy/methods , Parenteral Nutrition, Total/adverse effects , Predictive Value of Tests , Reoperation , Retrospective Studies , Risk Factors , Treatment Outcome , Western Australia/epidemiologyABSTRACT
BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. RESULTS: Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. CONCLUSION: This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.
Subject(s)
Anastomotic Leak/classification , Chylous Ascites/classification , Pancreatectomy/adverse effects , Pancreatic Neoplasms/surgery , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Anastomotic Leak/therapy , Chylous Ascites/etiology , Chylous Ascites/therapy , Consensus , Female , Humans , Internationality , Male , Pancreatectomy/methods , Postoperative Complications/classification , Postoperative Complications/therapy , Prognosis , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
La ascitis quilosa es la acumulación de líquido quiloso en la cavidad peritoneal. Puede ser primaria(defectos congénitos) o secundaria (obstrucción,traumatismos, etc.).Es nuestro objetivo poner en conocimiento una forma poco común de presentación de síndrome de maltrato infantil.Se presenta una niña de un año de edad, que ingresó a nuestro hospital por presentar un cuadro de maltrato infantil con distensión abdominal.Se realizaron estudios de laboratorio, diagnóstico por imágenes y una paracentesis de abdomen que arrojó como resultado un líquido compatible con quilo.Con el diagnóstico de ascitis quilosa se realizaron estudios complementarios que confirmaron un traumatismo abdominal por síndrome de maltrato infantil.La paciente evolucionó favorablemente con ayunoy nutrición parenteral por un período de un mes, y posteriormente con realimentación con dieta hipograsa.Es de hacer notar que la revisión bibliográfica demostró que de 41 casos de ascitis quilosa en edad pediátrica, 10% fueron secundarios a maltrato. Sitomamos el rango de edades de 2 meses a 2 años este porcentaje aumenta a 44%.
Subject(s)
Infant , Chylous Ascites/classification , Chylous Ascites/complications , Chylous Ascites/diagnosis , Chylous Ascites/therapy , Child Abuse , Abdominal Injuries/therapyABSTRACT
La ascitis quilosa es la acumulación de líquido quiloso en la cavidad peritoneal. Puede ser primaria(defectos congénitos) o secundaria (obstrucción,traumatismos, etc.).Es nuestro objetivo poner en conocimiento una forma poco común de presentación de síndrome de maltrato infantil.Se presenta una niña de un año de edad, que ingresó a nuestro hospital por presentar un cuadro de maltrato infantil con distensión abdominal.Se realizaron estudios de laboratorio, diagnóstico por imágenes y una paracentesis de abdomen que arrojó como resultado un líquido compatible con quilo.Con el diagnóstico de ascitis quilosa se realizaron estudios complementarios que confirmaron un traumatismo abdominal por síndrome de maltrato infantil.La paciente evolucionó favorablemente con ayunoy nutrición parenteral por un período de un mes, y posteriormente con realimentación con dieta hipograsa.Es de hacer notar que la revisión bibliográfica demostró que de 41 casos de ascitis quilosa en edad pediátrica, 10% fueron secundarios a maltrato. Sitomamos el rango de edades de 2 meses a 2 años este porcentaje aumenta a 44%.(AU)
Subject(s)
Infant , Chylous Ascites/complications , Child Abuse , Chylous Ascites/therapy , Chylous Ascites/diagnosis , Chylous Ascites/classification , Abdominal Injuries/therapyABSTRACT
A prospective study identified 45 patients with malignancy-related ascites among 448 ascites patients (10% of the total). Patients were categorized into five subgroups based on the pathophysiology of ascites formation. Each subgroup had a distinctive ascitic fluid analysis. Patients with peritoneal carcinomatosis but without massive liver metastases (53.3% of the patients with malignancy-related ascites) had a uniformly positive ascitic fluid cytology, high ascitic fluid protein concentration and low serum-ascites albumin gradient. Patients with massive liver metastases and no other cause for ascites formation (13.3% of the series) had a negative cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Those with peritoneal carcinomatosis and massive liver metastases (13.3% of the series) had a nearly uniformly positive ascitic fluid cytology, variable protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Chylous ascites (6.7%) was characterized by a milky appearance, negative cytology and an elevated ascitic fluid triglyceride concentration. Patients with hepatocellular carcinoma superimposed on cirrhosis (13.3%) had negative ascitic fluid cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and elevated serum and ascitic fluid alpha-fetoprotein concentration. Two-thirds of patients with malignancy-related ascites had peritoneal carcinomatosis; 96.7% of patients with peritoneal carcinomatosis had positive ascitic fluid cytology. Ascitic fluid analysis is helpful in identifying and distinguishing the subgroups of malignancy-related ascites.
