Successful laparoscopic management of chylous ascites following laparoscopic radical nephrectomy

A 44-year-old woman developed chylous ascites following laparoscopic transperitoneal left radical nephrectomy with para-aortic lymph node dissection. Because conservative managements failed to stop the lymphatic leakage, laparoscopic lymphostasis was performed. Drinking milk 6 h prior to the operation enabled visualization of chylous ascites. Although a definite fistula was hard to identify, most of the chylous leak disappeared after ligation of the para-aortic tissues at the distal and proximal ends of the previous lymph node dissection. Laparoscopic ligation of the para-aortic bundle of lymph ducts was effective in managing long-standing postoperative chylous ascites.