Chyle Leak Post Pancreatic Resection. When and why of Etiopathogenesis and how of Management

Abstract

Introduction: Pancreatic resections are associated with significant morbidity. While most of the complications are well documented in the literature, chyle leak gets scant attention. The aim of this article is to review the etiopathogenesis and management of chyle leak post pancreatic resection. Methods: A medline search of major articles in English literature of 2 or more cases of chyle leak and ascites were reviewed and the findings analysed. Results: A total of 8 studies were identified comprising of 5564 cases of pancreatic resections. Chyle leak was reported in 4.11% of these cases. Associated surgical procedures included, vascular resection and reconstruction in 36%, visceral resection in 44%, standard lymph node dissection in 59% and para-aortic manipulation. An average of 14.6 lymph nodes were harvested. Early enteric feeding was employed in 58%. The leak was noted at median postoperative period of 6 days. Most of the patients were managed conservatively with NPO, octreotide and in some cases TPN, followed by medium chain or low chain triglycerides, once the amount of leak reduced. Diagnostic paracentesis, lymphiscintigraphy, lymphangiogram, reexploration and ligation of leaking lymphatic vessels andperitoneol venous shunt were carried out in limited number of cases. Associated post operative complications included pancreatic fistula, intraabdominal abscess, sepsis, portal vein thrombosis, delayed gastric emptying. The mean time of discharge was 15 days post surgery. Conclusions: chyle leak is a rare complication following pancreatic resection. Factors predictive of chyle leak include increasing number of lymph nodes harvested, concomitant vascular resection and visceral resection and early enteral feeding. Majority of them are managed conservatively.