Chylous ascites after hepatopancreatobiliary surgery.

Abstract

BACKGROUND:

Postoperative chylous ascites following abdominal surgery is uncommon. It potentially induces malnutrition and immunodeficiency, contributing to increased mortality. In the field of hepatopancreatobiliary (HPB) surgery, no large studies have been conducted that focused on postoperative chylous ascites. The aim of this study was to determine the incidence, risk factors and management of chylous ascites following HPB surgery, with particular emphasis on pancreatic resection.

METHODS:

Consecutive patients who had HPB surgery between 2000 and 2011 at a single institution were reviewed retrospectively. Chyle leak was defined as 100 ml/day or more of milky, amylase-free peritoneal fluid with a triglyceride concentration of 110 mg/dl or above. Risk factors for chylous ascites associated with pancreatic resection and the clinical efficacy of octreotide in treating chylous ascites were evaluated.

RESULTS:

Of 2002 consecutive patients who underwent HPB surgery during the study period, 21 (1·0 per cent) developed chylous ascites. Chylous ascites occurred relatively frequently in patients who had a pancreatic resection, such as pancreaticoduodenectomy (3·3 per cent) or distal pancreatectomy (3·8 per cent). Multivariable analysis revealed that manipulation of the para-aortic area (P < 0·001), retroperitoneal invasion (P = 0·031) and early enteral feeding after operation (P < 0·001) were independent risk factors for chylous ascites following pancreatic resection. Octreotide treatment decreased drainage output of chylous ascites on day 1 after initiation of treatment (P = 0·002).

CONCLUSION:

Chylous ascites is a rare complication following HPB surgery. It is more common after pancreatic resection. Treatment with octreotide combined with total parenteral nutrition is recommended.

• Authors: S Kuboki, H Shimizu, H Yoshidome, M Ohtsuka, A Kato, H Yoshitomi, K Furukawa, M Miyazaki
• Journal: The British journal of surgery (Br J Surg) Vol. 100 Issue 4 Pg. 522-7 (Mar 2013) ISSN: 1365-2168 [Electronic] England
• PMID: 23288577 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Chemical References

• Gastrointestinal Agents
• Octreotide

Topics

• Biliary Tract Diseases (surgery)
• Biliary Tract Surgical Procedures
• Chylous Ascites (drug therapy, etiology)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Male
• Middle Aged
• Octreotide (therapeutic use)
• Pancreas (surgery)
• Pancreatectomy
• Pancreatic Diseases (surgery)
• Pancreaticoduodenectomy
• Postoperative Complications (drug therapy, etiology)
• Retrospective Studies
• Risk Factors