Abstract
BackgroundChyle leak is an uncommon form of ascites occurring due to the accumulation of lipid‐rich lymph into the peritoneal cavity. Traumatic injury to the lymphatic system due to pancreaticobiliary surgery can lead to this phenomenon.MethodWe retrospectively evaluated the data of 159 patients of pancreticobiliary surgery from January 2012 to December 2016. Five patients (5/137, 3.6%) sustained a chylous leak following pancreaticoduodenectomy and one patient (1/22, 4.5%) sustained a chylous leak following Roux‐en‐Y hepaticojejunostomy for postcholecystectomy biliary stricture.ResultsAverage daily output was 441 mL (range: 150–800 mL/day), and total duration of output was 16.5 days (range: 4–35 days). Mean hospital stay increased to 19.1 days (range: 10–40 days). All the patients were successfully managed conservatively with a combination of customized enteral feeds, supplemental parenteral nutrition, and octreotide. One patient required additional percutaneous drainage.ConclusionChyle leak can be successfully treated with conservative management but at the cost of increased hospital stay.
Highlights
IntroductionFirst described by Morton in 1694, is an uncommon form of ascites characterized by a creamy-milky fluid rich in triglycerides.[1] A chyle leak occurs frequently after aortic surgery and retroperitoneal lymph node dissection in urological surgery[2,3] but can complicate pancreatobiliary surgery in 1.1–16.3% of cases.[4,5] Disruption of visceral lymphatic channels, including cisterna chyli during dissection, leads to chyle leak.[6]
Chylous ascites, first described by Morton in 1694, is an uncommon form of ascites characterized by a creamy-milky fluid rich in triglycerides.[1]
Kocherization of the duodenum up to the aorta is a standard step during pancreaticoduodenectomy to facilitate resection and to remove the lymph nodes for R0 resection
Summary
First described by Morton in 1694, is an uncommon form of ascites characterized by a creamy-milky fluid rich in triglycerides.[1] A chyle leak occurs frequently after aortic surgery and retroperitoneal lymph node dissection in urological surgery[2,3] but can complicate pancreatobiliary surgery in 1.1–16.3% of cases.[4,5] Disruption of visceral lymphatic channels, including cisterna chyli during dissection, leads to chyle leak.[6]. Chylous fluid is rich in triglycerides, lymphocytes, and immunoglobulin; a large-volume loss leads to increased morbidity because of metabolic consequences, that is, malnutrition, immunodeficiency, and even infections.[7] The occurrence of this complication after hepaticojejunostomy in benign biliary stricture (BBS) has not been described in English literature. Conclusion: Chyle leak can be successfully treated with conservative management but at the cost of increased hospital stay
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