A Review of Incidence, Risk Factors, and Management of Chyle Leak Following Abdominal Surgery

Abstract

Chyle leak (CL) is an uncommon complication of abdominal surgery; the true incidence is difficult to appreciate. Unlike other complications, CL is poorly described and current treatment options are largely not evidence-based. This article aims to review the incidence, aetiology and risk factors associated with CL following abdominal procedures and propose a management algorithm. We performed a search of multiple databases and identified studies on CL following abdominal procedures. The data was compiled and used to identify high-risk procedures and risk factors for CL. Incidence was highly variable between studies and was highest following pancreatic resection and retroperitoneal lymph node dissection. No high-quality studies have calculated the incidence of CL following several commonly performed abdominal operations e.g. hepatectomy. Numerous studies identified a number of resected lymph nodes, a number of involved lymph nodes and retroperitoneal dissection as independent risk factors. Optimum management remains a source of debate. Most cases of CL are self-limiting and will resolve within 2-3 weeks following conservative measures alone. Severe cases can result in increased length of stay and have metabolic, immunologic, and economic implications. Following a diagnosis of CL, we advise starting patients on octreotide and commencing a low-fat medium-chain triglyceride-based diet. If this fails then total parenteral nutrition can be considered. Novel minimally invasive techniques and surgical options should be kept as a last resort for those with significant complications, or those who have failed a non-operative approach.