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Postoperative Chyle Leak After Major Pancreatic Resections In Patients Who Receive Enteral Feed: Risk Factors And Management Options

Mohammed Abu Hilal, D M Layfield, Francesco di Fabio, Irantzu Arregui-Fresneda, I G Panagiotopoulou, Thomas H. Armstrong, Neil William Pearce, Colin David Johnson
Published 2013 · Medicine
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BackgroundChyle leak complicates 1.3–10.8 % of pancreatic resections. Universal use of parenteral nutrition following pancreatic resection may reduce the incidence of chyle leak. However, this denies the majority of patients who do not develop chyle leak the benefits of enteral nutrition (EN). The present study aimed to identify risk factors for chyle leak following pancreatic resection within a single institution where EN was used universally. MethodsAll patients who underwent pancreatic resection between January 2007 and December 2010 were identified retrospectively. The patients had been treated according to a common unit protocol of enteral feeding; those developing chyle leak were switched to a medium-chain triglyceride (MCT) regimen. Clinical progress and recovery after surgery was evaluated. Multivariate analysis was performed to identify factors associated with chyle leak. ResultsA total of 245 patients underwent major pancreatic resection (231 pancreatoduodenectomy, 14 total pancreatectomy). Chyle leak complicated 40 cases (16.3 %). After multivariate analysis, both extensive lymphadenectomy (P = 0.002) and postoperative portal/mesenteric venous thrombosis (PVT) (P = 0.009) were independently linked with a higher incidence of chyle leak. The development of chyle leak was not associated with poorer survival or prolonged duration of hospital stay. It was associated with a significantly increased duration of abdominal drainage and reduced likelihood of early hospital discharge (P = 0.026).ConclusionsUniversal use of enteral feeding is associated with a high rate of chyle leak following pancreatic resection. Patients undergoing extensive lymphadenectomy or those who develop PVT postoperatively are at increased risk. Development of chyle leak was not associated with additional morbidity or mortality following implementation of an MCT regimen. The implication is that reactive management of chyle leak with conversion to a MCT predominant diet is safe.
This paper references
Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing.
D Schroeder (1991)
Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options
Hassan Malik (2007)
Incidence and Management of Chyle Leaks Following Pancreatic Resection: A High Volume Single-Center Institutional Experience
Lia Assumpcao (2008)
Chyloperitoneum following treatment for advanced gynecologic malignancies
John P Geisler (1994)
Chylous ascites following heart transplantation.
María G. Crespo-Leiro (1998)
Allowing Normal Food at Will After Major Upper Gastrointestinal Surgery Does Not Increase Morbidity: A Randomized Multicenter Trial
K. Lassen (2008)
Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy.
K. Goonetilleke (2006)
Artificial Nutrition After Pancreaticoduodenectomy
Luca Gianotti (2000)
Chylous ascites following retroperitoneal lymph node dissection for testis cancer.
P. M. T. Weston (1992)
Chylous ascites following liver resection—case report
Krishnan Prabhakaran (2004)
Chylous ascites after
S Asfar (1994)
Beneficial effect of enteral feeding.
K. Kudsk (2007)
The diagnosis and management of postoperative chylous ascites.
I. Leibovitch (2002)
Postoperative Chylous Ascites: A Rare Complication of Laparoscopic Nissen Fundoplication
T. S. Bacelar (2003)
ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation.
A. Weimann (2006)
Management of retroperitoneal chylous leakage.
M M DeHart (1994)
Predicting basal metabolic rate, new standards and review of previous work
Schofield Wn (1985)
Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial1)
Sanne Nissink (2011)
Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial
F. Bozzetti (2001)
Chylous ascites after pancreaticoduodenectomy: introduction of a grading system.
Niels A. van der Gaag (2008)
Predicting basal metabolic rate, new standards and review of previous work.
W. Schofield (1985)
Chyle leaks: consensus on management?
Addy Smoke (2008)
Improvement of Delayed Gastric Emptying in Pylorus-Preserving Pancreaticoduodenectomy: Results of a Prospective, Randomized, Controlled Trial
M. Tani (2006)
Chylous ascites: a rare complication of vagotomy. Case report.
Mustafa al-Mousawi (1991)
Results of curative gastrectomy for carcinoma of the distal third of the stomach.
C C Wu (1996)
Chylous ascites after liver transplantation.
Sami K. Asfar (1994)
Effect of immediate postoperative enteral nutrition on body composition, muscle function and wound healing
D Schroeder (1991)
a randomised multicenter trial
K Lassen (2013)
Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine.
P. Guillem (1999)
Chylous ascites: diagnosis, causes and treatment.
P. Laterre (2000)
Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine.
P. Guillem (1999)
Feeding patients following pancreaticoduodenectomy: a UK national survey.
Mary L. Phillips (2009)
Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet.
M. Braga (1998)
Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group.
S. Pedrazzoli (1998)

This paper is referenced by
chyle leak after pancreas surgery a review
Kamleshsingh Shadhu (2018)
The TRIANGLE operation - radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study.
Thilo Hackert (2017)
Chyle Leak Post Pancreatic Resection. When and why of Etiopathogenesis and how of Management
Norman Oneil Machado (2015)
Classifying Enteral Nutrition: Tailored for Clinical Practice
Berkeley N Limketkai (2019)
Incidence, risk factors and management of chylothorax post-oesophagectomy for oesophageal carcinoma in an Australian institution
Duc Khuong Nguyen (2020)
Chyle Leakage after Robotic and Open Pancreaticoduodenectomy.
Bor-Uei Shyr (2020)
Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study
Marion van der Kolk (2017)
Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery
Marc G. Besselink (2017)
Feeding patients with preoperative symptoms of gastric outlet obstruction after pancreatoduodenectomy: Early oral or routine nasojejunal tube feeding?
Arja Gerritsen (2015)
Management of Chyle Leaks Following Pancreatic Resection
Neda Rezaee (2015)
Relationship Between Early Oral Intake Post Pancreaticoduodenectomy and Chyle Leakage: A Retrospective Cohort Study.
Zheng Chen (2019)
Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy.
Kazuki Moro (2016)
Management of chylous ascites following pancreaticobiliary surgery
Harjeet Singh (2019)
Emphysematous cystitis: an unreported complication after pancreaticoduodenectomy.
Traian Dumitrascu (2015)
Chyle leak after pancreatic surgery: validation of the International Study Group of Pancreatic Surgery classification
Salvatore Paiella (2018)
Chylous Ascites and Chylothorax after Pancreaticoduodenectomy: Case Report and Literature
Jana E Hambley (2015)
Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery
Oliver Strobel (2017)
The Use of Medium-Chain Triglycerides in Gastrointestinal Disorders
Neha D. Shah (2017)
Manual Lymph Drainage and Fascial Release for the Treatment of Chylous Ascites Following Radical Nephrectomy: A Case Report
Mary Ellen Kramp (2016)
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