Postoperative chylous ascites--the urologist's view

Postoperative chylous ascites is a rare complication of retroperitoneal surgery caused by incidental disruption of major retroperitoneal lymphatics and is associated with serious mechanical, nutritional and immunological consequences due to the constant loss of protein and lymphocytes. Different management schemes may be used successfully to treat chylous ascites. Treatment should be adjusted to the severity of the lymphatic leak and its consequences. The management algorithm presented in this article is based on a step-up approach aimed at reducing lymph flow and maintaining nutritional balance. It integrates repeated palliative paracenteses, dietary interventions, total parenteral nutrition therapy, somatostatin therapy, surgical closure of the lymphatic fistula and peritoneovenous shunting. The prognosis of chylous ascites is generally good, with the majority of the cases responding to conservative measures.