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Chylous ascites after laparoscopic lymph node dissection in gynecologic malignancies
Yuqing Zhao1, Weiguo Hu1, Xiaofan Hou1
1Department of Gynecology, Gynecologic and Obstetric Hospital, Fudan University, Shanghai, China.
Study Objective:
To evaluate the clinical presentation, epidemiology, risk factors, and treatment of chylous ascites after laparoscopic lymphadenectomy to treat gynecologic malignancies.
Design:
Retrospective study with review of outcomes (Canadian Task Force classification II-3).
Setting:
University research hospital.
Patients:
From November 2009 to December 2012, 997 patients underwent laparoscopic lymphadenectomy to treat gynecologic malignancies at our hospital.
Interventions:
Postoperative chylous ascites resolved with continuous drainage and dietary restriction or fasting.
Measurements And Main Results:
Nine of 997 patients (0.9%) developed chylous ascites postoperatively. Mean age of these 9 patients was 47.5 years. Median time from operation to development of chylous ascites was 4 days (range, 2-9 days). Chylous ascites developed on either day 1 in 6 patients, day 2 in 2 patients, and day 8 in 1 patient, after food intake. We found that postoperative chylous ascites was associated more with para-aortic lymphadenectomy than with pelvic lymphadenectomy (overall incidence, 0.9%; 4.08% in the para-aortic lymphadenectomy group vs 0.35% in the pelvic lymphadenectomy group). In all patients, chylous ascites resolved with conservative treatment. Median time to resolution was 7 days (range, 3-9 days). Drainage tubes were removed within 9 days after treatment.
Conclusions:
The incidence of chylous ascites after laparoscopic lymphadenectomy was 0.9%. Para-aortic lymphadenectomy was associated with postoperative chylous ascites. Chylous ascites was successfully treated with conservative management. An abdominal drainage tube can be a simple and effective approach and should be considered in the treatment of chylous ascites.
