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Peri-operative chylous ascites

P J Gaglio¹, C B Leevy, B Koneru

¹UMDNJ-New Jersey Medical School Liver Center, Newark 07103, USA.

Journal of Medicine

|January 1, 1996

Summary

Chylous ascites rarely complicates liver transplantation. Post-operative cases are typically transient and linked to retroperitoneal dissection, not requiring specific lymphatic management.

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Area of Science:

Gastroenterology and Hepatology
Surgical Oncology
Transplant Surgery

Background:

Chylous ascites, characterized by lymphatic fluid accumulation, can arise from various conditions including liver disease and surgical disruption of lymphatics.
Surgical intervention, particularly retroperitoneal dissection, poses a risk of lymphatic injury.
Current practices suggest ligating or stenting hepatic lymphatics during liver transplantation to prevent chylous fluid buildup.

Observation:

This study evaluated 180 patients undergoing orthotopic liver transplantation to assess the incidence of chylous ascites and the necessity of lymphatic ligation.
One patient with pre-existing chylous ascites experienced resolution post-transplantation.
Three patients developed post-operative chylous ascites following procedures involving retroperitoneal dissection for biliary anastomosis or hepatic artery grafting.

Findings:

Post-operative chylous ascites occurred in 3 out of 180 patients (1.67%) after orthotopic liver transplantation.
These cases of chylous ascites were transient and resolved spontaneously without complications.
No specific management of transected hepatic lymphatics was required to achieve resolution.

Implications:

The findings suggest that routine ligation or stenting of hepatic lymphatics is unnecessary during orthotopic liver transplantation.
Transient chylous ascites post-transplantation is primarily associated with retroperitoneal dissection rather than the liver graft itself.
This research may influence surgical protocols, potentially simplifying procedures and reducing unnecessary interventions.

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