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Chylous ascites after hepatopancreatobiliary surgery
S Kuboki1, H Shimizu, H Yoshidome
1Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
The British Journal of Surgery
|January 5, 2013
Summary
Postoperative chylous ascites is a rare complication after hepatopancreatobiliary (HPB) surgery, particularly pancreatic resections. Octreotide treatment combined with total parenteral nutrition is recommended for managing this condition.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Abdominal Surgery
Background:
- Postoperative chylous ascites is an uncommon complication of abdominal surgery.
- It can lead to malnutrition, immunodeficiency, and increased mortality.
- Large-scale studies on chylous ascites in hepatopancreatobiliary (HPB) surgery are lacking.
Purpose of the Study:
- To determine the incidence of postoperative chylous ascites following HPB surgery.
- To identify risk factors associated with chylous ascites, especially after pancreatic resection.
- To evaluate the clinical efficacy of octreotide in managing chylous ascites.
Main Methods:
- Retrospective review of consecutive patients undergoing HPB surgery (2000-2011).
- Definition of chyle leak: ≥100 ml/day milky peritoneal fluid with triglycerides ≥110 mg/dl.
- Multivariable analysis to identify risk factors and assess octreotide efficacy.
Main Results:
- 21 out of 2002 patients (1.0%) developed chylous ascites.
- Higher incidence in pancreatic resections (pancreaticoduodenectomy 3.3%, distal pancreatectomy 3.8%).
- Independent risk factors: para-aortic manipulation, retroperitoneal invasion, early enteral feeding. Octreotide reduced drainage output (P=0.002).
Conclusions:
- Chylous ascites is a rare but significant complication of HPB surgery, more frequent after pancreatic resection.
- Para-aortic manipulation, retroperitoneal invasion, and early enteral feeding are key risk factors.
- Octreotide combined with total parenteral nutrition is the recommended treatment approach.
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