Abstract
BackgroundWe aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect.MethodsData from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure.ResultsIn the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19).ConclusionsChylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.
Highlights
Small bowel and right colonic neoplasms tend to spread to the central mesentery via the lymph flow
D3 extended mesenterectomy entails the removal of all fatty tissue from the predefined D3 area [2], made possible and safe through preoperative 3D multi-detector computed tomography (MDCT) vascular anatomy reconstruction [3, 4]
Literature suggests that the incidence of chylous ascites after surgery, i.e., urological, gynecological, vascular, and liver, is estimated to be between 0.17 and 7.0% [5], while the incidence rates may be higher after gastric, colorectal, pancreatic, and small bowel surgery with a rate between 1.0 and 11.8% [1, 5, 6]
Summary
Small bowel and right colonic neoplasms tend to spread to the central mesentery via the lymph flow. Literature suggests that the incidence of chylous ascites after surgery, i.e., urological, gynecological, vascular, and liver (non-intestinal lymph), is estimated to be between 0.17 and 7.0% [5], while the incidence rates may be higher after gastric, colorectal, pancreatic, and small bowel surgery (intestinal lymph) with a rate between 1.0 and 11.8% [1, 5, 6]. We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was implemented in the 99 patients as a prophylactic measure
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