Chylous ascites as a complication of left sided robot-assisted laparoscopic partial nephrectomy

The aim of the study was to present a case series of the sparsely reported complication of chylous ascites (CA) after left sided robot-assisted laparoscopic partial nephrectomy (RALPN), identify possible risk factors for the development of postoperative CA, and explore current recommendations for identification, management and prevention of CA.

A retrospective review of patients that were treated with a RALPN during a one year time period (August 2012 to August 2013) by one surgeon at our institution was conducted. A total of 12 patients were included in the study. Demographics, tumor characteristics, and perioperative outcomes were assessed.

Three patients in the study experienced postoperative CA. All three patients had left sided surgery. The initial clinical suspicion for CA was raised due to complaints of abdominal pain with increased milky appearance of JP fluid. JP triglycerides were elevated in all three patients. The patients responded to conservative measures, with two patients treated with medium chain triglyceride diets and one patient treated with total parenteral nutrition (TPN). Among the patients treated with RALPN, the group that was diagnosed with postoperative CA (CA group) was found to have a statistically significant lower average body mass index (BMI) as compared to the group that did not have CA (non-CA group) (24.67 kg/m2 in the CA group versus 31.77 kg/m2 in the non-CA group; P = 0.026). Other demographic data, tumor characteristics, and perioperative outcomes were similar in both groups.

CA as a result of RALPN is a newly reported and rare postoperative complication. As utilization of RALPN continues to increase, urologists should be aware of this possible complication and be adept at diagnosing and managing CA. We suggest that left sided retroperitoneal surgery and a lower BMI preoperatively be considered risk factors for developing this complication.