Chylous Ascites Management After Pancreatic Surgery

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Postoperative chylous ascites (CA) is an uncommon complication following pancreatic surgery.
• Untreated CA can lead to malnutrition, immunodeficiency, and increased morbidity/mortality.
• Identifying risk factors for CA and treatment failure is crucial for improved patient outcomes.

Purpose of the Study:

• To identify risk factors associated with the onset of chylous ascites (CA) after pancreatic surgery.
• To determine factors contributing to the failure of conservative treatment (CT) for CA.
• To optimize the management of CA following pancreatic resection.

Main Methods:

• Retrospective review of patients undergoing pancreatic surgery between 2004 and 2014.
• Analysis of demographic, clinical, and pathological data to identify CA risk factors.
• Comparison of patients treated successfully with CT alone versus those requiring bipedal lymphangiography (BPLAG) to identify CT failure risk factors.

Main Results:

• Fifteen patients (2.4%) developed CA post-pancreatic surgery.
• Para-aortic lymph node sampling and early enteral feeding were independent risk factors for CA (OR 6.36, p=0.024 and OR 12.18, p=0.02, respectively).
• Conservative treatment (CT) succeeded in 10 patients; 5 required additional BPLAG. No significant risk factors for CT failure were identified.

Conclusions:

• Due to the rarity of postoperative CA, treatment consensus is lacking.
• Conservative treatment (CT) should be the initial approach for all CA patients.
• Bipedal lymphangiography (BPLAG) is a safe and effective procedure that warrants earlier consideration in management.