Chylous ascites is a difficult, albeit uncommon complication of laparoscopic live donor
nephrectomy (LLDN). Lymphatic leak is believed to be a result of injury to the cisterna chyli, regional lymph nodes, or other peri-aortic lymphatics intraoperatively. Recommended management with
dietary modifications can result in
malnutrition and immunodeficiency. We present four patients who developed
chylous ascites following LLDN. Approach to these patients evolved over time. Our initial two patients were successfully treated with a combination of surgical intervention followed by drain placement, after the failure of
conservative management. The latter two cases were successfully treated with prompt intra-abdominal drain placement, without
dietary modifications. Our cohort challenges the standard of care for treatment of
chylous ascites after LLDN. We believe that prompt diagnosis and placement of an intra-abdominal drain can be used safely in select patients that develop this complication. We hypothesize that continuously draining the lymphatic leak, thus avoiding the re-accumulation of
ascites, allows bowel and mesentery to make contact and adhere to the retroperitoneal tissue. We believe that prompt, initial, percutaneous drain placement is a viable alternative to both conservative and reoperative management in the treatment of
chylous ascites after LLDN and should be considered as a reasonable first-line
therapy.