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Chylous Ascites After Pancreaticoduodenectomy: Introduction Of A Grading System.

Niels A. van der Gaag, Andries C. Verhaar, Elizabeth B. Haverkort, Olivier R. C. Busch, Thomas Matthijs van Gulik, Dirk Joan Gouma
Published 2008 · Medicine
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BACKGROUND Chylous ascites (CA) is a complication that follows thoracic and abdominal surgery, recognized after provocation by enteral feeding and characterized by its milky appearance from an elevated triglyceride level. The aim of this study was to evaluate incidence, management, and predisposing factors of CA and its impact on outcomes after pancreaticoduodenectomy. STUDY DESIGN Between 1996 and 2007, 609 consecutive patients underwent pancreaticoduodenectomy. Patients having a drain output with a milky appearance, and with a triglyceride level greater than 1.2 mmol/L, were compared with patients without significant drain production or with a low triglyceride level. Management of CA was reviewed. RESULTS Sixty-six patients had isolated CA (11%) of any measurable volume, 440 patients (72%) had no CA, and 109 patients (16%) were excluded from analysis. CA was diagnosed on postoperative day 6 (median; interquartile range 5 to 8), generally after introduction of a normal (polymeric low-chain-triglyceride) diet. Female gender (odds ratio, 1.79; 95% CI, 1.05 to 3.03) and chronic pancreatitis at pathology (odds ratio, 2.52; 95% CI, 1.19 to 5.32) were independently associated with development of isolated CA. A low-chain-triglyceride-restricted diet was initiated in 47 patients, 3 were started on total parenteral nutrition, and an expectative approach was followed in 16 patients. CA resolved after 3.5 days (median; interquartile range, 2 to 5). Isolated CA was significantly associated with prolonged hospital stay (p=0.002). CONCLUSIONS We propose a novel definition and grading system for CA after pancreaticoduodenectomy, according to which the incidence is 9%, with clinically significant CA occurring in 4% (grades B and C). Although female gender and (focal) chronic pancreatitis were associated with development of isolated CA, no predisposing factors that could readily anticipate CA were identified. Isolated CA was associated with prolonged hospital stay.
This paper references
Postopera - tive chylous ascites : diagnosis and treatment . A series report and literature review
CJ Ablan (1990)
10.1097/00000658-200110000-00008
Prospective Randomized Clinical Trial of the Value of Intraperitoneal Drainage After Pancreatic Resection
Kevin C. P. Conlon (2001)
10.1111/j.1365-277X.2004.00505.x
Peripheral parenteral nutrition in a case of chyle leak following neck dissection.
Stephen A C Morris (2004)
10.1288/00005537-199007000-00014
The management of chyle fistula.
Jeffrey D. Spiro (1990)
10.1097/00000658-199901000-00017
Thoracic duct in patients with multiple organ failure: no major route of bacterial translocation.
Lucienne C Lemaire (1999)
Systematic review and meta - analysis of standard and extended lymphadenectomy in pancreatodu - odenectomy for pancreatic cancer
CW Michalski (2007)
10.1097/01.sla.0000225046.43968.eb
Evidence forward, drainage on retreat: still we ignore and drain!?
M. Büchler (2006)
10.1067/mtc.2002.124386
Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer.
K. Shimizu (2002)
10.1159/000018744
A Surgical and Pathological Based Classification of Resective Treatment of Pancreatic Cancer
S. Pedrazzoli (1999)
10.1001/archsurg.1967.01330160110015
Chylous ascites following pancreatoduodenectomy.
William M. Walker (1967)
10.1002/(SICI)1097-0347(199607/08)18:4<347::AID-HED6>3.0.CO;2-Y
Systematic approach to the treatment of chylous leakage after neck dissection.
H H de Gier (1996)
10.1016/j.athoracsur.2005.02.076
Incidence and management of chyle leakage after esophagectomy.
Sjoerd M. Lagarde (2005)
10.1097/00000658-199709000-00016
Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.
James M. Watters (1997)
10.1097/00000658-195404000-00016
POSTOPERATIVE CHYLOTHORAX
Thomas G. Baffes (1954)
10.1053/ejso.1998.0612
The standard diagnostic work-up and surgical treatment of pancreatic head tumours.
D. Gouma (1999)
The lipoprotein profile of chylous and nonchylous pleural effusions.
Bruce A. Staats (1980)
10.1016/0196-0709(92)90053-V
Lipid and volume analysis of neck drainage in patients undergoing neck dissection.
Grayson K. Rodgers (1992)
10.1016/j.surg.2005.05.001
Postoperative pancreatic fistula: an international study group (ISGPF) definition.
C. Bassi (2005)
10.1016/S0929-6646(09)60154-6
Hypertriglyceridemia-associated acute pancreatitis with chylous ascites in pregnancy.
Shih-Chang Chuang (2006)
10.1016/S0022-5347(01)69064-5
The diagnosis and management of postoperative chylous ascites.
I. Leibovitch (2002)
10.1016/S0002-9610(05)81055-4
Management of chyloperitoneum after abdominal aortic surgery.
T. S. Pabst (1993)
10.1016/j.juro.2006.06.016
Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience.
J. Evans (2006)
[Chylous ascites, a rare complication of aortic surgery].
Zuhir Halloul (1995)
Chylous effusions secondary to pancreatitis: case report and review of the literature.
J P Goldfarb (1984)
10.1378/chest.117.3.902
Conservative treatment of postsurgical lymphatic leaks with somatostatin-14.
J M Collard (2000)
10.1177/000348940111000416
Bilateral Chylothorax following Neck Dissection: A New Method of Treatment
K Al-Sebeih (2001)
10.1016/S0022-5223(00)70123-1
Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation.
Stefano Merigliano (2000)
10.1097/01.sla.0000218077.14035.a6
Early Removal of Prophylactic Drains Reduces the Risk of Intra-abdominal Infections in Patients With Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients
Manabu Kawai (2006)
Management of chylothorax after pulmonary resection.
Masayuki Haniuda (1995)
10.1385/IJGC:27:1:83
Treatment of chyloperitoneum after extended lymphatic dissection during duodenopancreatectomy
Otto Kollmar (2000)
10.1016/S0002-9610(02)00866-8
Multimodal strategies to improve surgical outcome.
H. Kehlet (2002)
[Chylothorax and chylous ascites following surgery of an inflammatory aortic aneurysm. Case report with review of the literature].
J Combe (1992)
Conservative management of chylous ascites complicating aortic surgery: a case report.
A J Petrasek (1996)
10.1016/S1051-0443(98)70382-3
Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study.
C. Cope (1998)
10.1016/S0003-4975(98)00361-0
Treatment of a persistent postoperative chylothorax with somatostatin.
P. Rimensberger (1998)
System - atic review of perioperative nutritional supplementation in patients undergoing pancreatoduodenectomy
KS Goonetilleke (2006)
10.1159/000108324
Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options
Hassan Malik (2007)
10.1097/00000658-199710000-00016
A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy.
M. Heslin (1997)
10.1067/msy.2000.109502
Chylous ascites: a collective review.
O. O. Aalami (2000)



This paper is referenced by
10.1002/bjs.10316
Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery
Oliver Strobel (2017)
10.1016/j.hpb.2015.10.006
Fluid collection after distal pancreatectomy: a frequent finding.
Christin Tjaden (2016)
Emphysematous cystitis: an unreported complication after pancreaticoduodenectomy.
Traian Dumitrascu (2015)
10.1016/j.isjp.2017.09.001
Nutritional risk in major abdominal surgery: NURIMAS Liver (DRKS00010923) – protocol of a prospective observational trial to evaluate the prognostic value of different nutritional scores in hepatic surgery
P. Probst (2017)
10.4067/S0718-40262014000500011
ASCITIS QUILOSA ASOCIADA A PANCREATITIS AGUDA
C BeatrizPérez (2014)
10.21037/hbsn.2019.06.11
Prospective study to evaluate the prognostic value of different nutritional assessment scores in liver surgery: NURIMAS Liver (DRKS00006340)
P. Probst (2019)
10.3919/JJSA.71.1603
OCTREOTIDE-ACETATE TREATMENT OF CHYLOUS ASCITES AFTER SUBTOTAL STOMACH-PRESERVING PANCREATODUODENECTOMY AND PORTAL VEIN RESECTION-A CASE REPORT-
Mai Tsutsui (2010)
10.1002/jgh3.12179
Management of chylous ascites following pancreaticobiliary surgery
Harjeet Singh (2019)
10.1038/ejcn.2015.48
Nutritional management in patients with chyle leakage: a systematic review
Bryan Steven (2015)
10.15226/2374-815X/2/3/00144
Chyle Leak Post Pancreatic Resection. When and why of Etiopathogenesis and how of Management
Norman Oneil Machado (2015)
10.2214/AJR.12.10008
Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment.
Ryota Kawasaki (2013)
10.3919/JJSA.75.1674
A Case of Intra-abdominal Local Recurrence following Surgery for Pancreatic Cancer that was Diagnosed due to the Appearance of Delayed Chylous Ascites
Masaki Nara (2014)
10.1016/J.CIRESP.2012.10.001
Eficacia del octreótido en el tratamiento de la fístula quilosa asociada a enfermedades pancreáticas
Fabián Zárate Moreno (2013)
10.11613/BM.2014.014
Pleural, peritoneal and pericardial effusions – a biochemical approach
Lara Milevoj Kopčinović (2014)
10.1016/j.surg.2017.06.019
Reply to a letter to the editor regarding the International Study Group on Pancreatic Surgery definition and classification of chyle leak after pancreatic operation.
L B van Rijssen (2017)
10.1002/ccr3.866
Lymphangiography and subsequent sclerotherapy can be easily applied by cannulation of the lymph duct with a catheter for the neonatal central vein
Tomomi Kimura (2017)
10.12968/hmed.2015.76.4.C60
Overview of pancreatic resections: postoperative management.
Bobby V.M. Dasari (2015)
10.1016/J.CIRENG.2013.09.014
Efficacy of Octreotide in the Treatment of Chyle Fistulas Associated With Pancreatic Disease
Fabián Zárate Moreno (2013)
10.1007/s00268-013-1919-7
Drainage Volume After Pancreaticoduodenectomy Is a Warning Sign of Chyle Leakage That Inversely Correlates With a Diagnosis of Pancreatic Fistula
Jae Keun Kim (2013)
10.1016/j.amjsurg.2015.04.012
Treatment options for chylous ascites after major abdominal surgery: a systematic review.
Maximilian Weniger (2016)
10.29011/2575-9760.001176
chyle leak after pancreas surgery a review
Kamleshsingh Shadhu (2018)
The value of nutritional assessment in major abdominal surgery
Elizabeth B. Haverkort (2014)
10.1080/08941939.2019.1663378
Relationship Between Early Oral Intake Post Pancreaticoduodenectomy and Chyle Leakage: A Retrospective Cohort Study.
Zheng Chen (2019)
Incidence and risk factors of chylous ascites after pancreatic resection.
Wu Pan (2015)
10.1007/978-1-4939-2223-9_29
Management of Chyle Leaks Following Pancreatic Resection
Neda Rezaee (2015)
10.1016/j.amjsurg.2013.01.033
Incidence and risk factors of chylous ascites after colorectal cancer surgery.
Se-Jin Baek (2013)
10.1016/j.avsg.2020.04.063
Lymphangiography with or without Embolization for the Treatment of Postoperative Lymphatic Leak of the Abdomen and Pelvis: a Case Series and Systematic Review.
Pyeong Hwa Kim (2020)
10.1007/978-3-662-47181-4_33
Rare Complications After Pancreatectomy
Dong Sup Yoon (2017)
10.1007/978-1-4614-8503-2_42-1
Feeding Routes After Pancreatoduodenectomy
Arja Gerritsen (2014)
10.1016/j.surg.2016.06.058
Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery
Marc G. Besselink (2017)
10.1097/SLA.0b013e3182a6f529
Antecolic Versus Retrocolic Route of the Gastroenteric Anastomosis After Pancreatoduodenectomy: A Randomized Controlled Trial
W. Eshuis (2014)
10.1016/j.ctim.2014.10.006
Chylous ascites treated by traditional Chinese herbal medicine: a case report and discussion.
Lijuan Xiu (2015)
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