A rare complication after laparoscopic donor nephrectomy: Chyle leak - A case report

Simon, Sneha P; Thomas, Jim; Tidayath, Balagopal Nair; Bhat, Sanjay H

doi:10.4103/ijot.ijot_43_20

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…This variant may lead to damage to the right LLT during LDN. Chyle leak after LDN is a rare complication [5,6,9,10]. Because of its location immediately right to the abdominal aorta, the cisterna chyli and its branches can be damaged during dissection of the kidney and renal vessels.…”

Section: Discussionmentioning

confidence: 99%

Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

Dung

Vũ

et al. 2023

Korean J Transplant

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Laparoscopic donor nephrectomy (LDN) is increasingly popular because of its advantages over open surgery. Chyle leak after donor nephrectomy is a rare but potentially lethal complication if not treated appropriately. We describe a case of a 43-year-old female patient with no remarkable history who presented a chyle leak on day 2 after right transperitoneal LDN. Since conservative treatment failed, the patient underwent magnetic resonance imaging (MRI) and intranodal lipiodol lymphangiography, which confirmed the chyle leak from the right lumbar lymph trunk into the right renal fossa. The chyle leak was percutaneously embolized twice, on postoperative day (POD) 5 and POD 10, by a mixture of N-butyl-2-cyanoacrylate and lipiodol. The drainage fluid decreased significantly after the second embolization. The subhepatic drainage tube was withdrawn on POD 14, and the patient was discharged on POD 17. MRI lymphangiography and intranodal lipiodol lymphangiography effectively identified the chyle leak point. Percutaneous embolization seems to be a safe, effective method for treating high-output chyle leaks.

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Section: Discussionmentioning

confidence: 99%

Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

Dung

Vũ

et al. 2023

Korean J Transplant

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“…This report emphasizes the importance of early management using a less invasive approach once a high output leak is detected. Simon et al 6 reported a rare case of chylothorax after left LDN, which was managed with intercostal drain placement and early laparoscopic ligation of the leak site on PSD7.…”

Section: Discussionmentioning

confidence: 99%

“…Ligation of lymphatics with clips or sutures is of utmost importance during hilar and retroperitoneal dissection. 6 The use of the Ligasure device for coagulation of lymphatics was significantly associated with CL after liver transplant. 7 Meticulous dissection is needed in the paraaortic region to prevent damage to the cisterna chyli.…”

Section: Discussionmentioning

confidence: 99%

“…Simon et al 6 reported a rare case of chylothorax after left LDN, which was managed with intercostal drain placement and early laparoscopic ligation of the leak site on PSD7.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Those who did not respond to these measures underwent various interventions, including radiological procedures, minimally invasive procedures, or major surgeries. 3,6,14 The exact timing for considering these invasive procedures varied across different reports from 6 days to 8 weeks. 2,3,15 Delay can be associated with complications like a cachexic condition due to nutritional loss, infections due to poor immunity, and anxiety and depression caused by uncertainty regarding treatment measures.…”

Section: Discussionmentioning

confidence: 99%

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Post-operative chyle leak following nephrectomy: Inference from tertiary care center and review of literature

Sarangi,

Bhirud,

Sandhu

et al. 2023

Urologia

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Objectives: Lymphatic channels (LC) are not as prominent as blood vessels, so they tend to get damaged during surgical procedures. It can present with chyle leak in the postoperative period. We aimed to study the occurrence of chyle leak in patients undergoing nephrectomy and its management. Methods: During the period of January 2021 and January 2023, 158 adult patients underwent nephrectomy for various reasons like non-functioning kidney, donor nephrectomy, and malignancy. We retrospectively analyzed data of patients who had chyle leak after nephrectomies. Results: Eight patients out of the 158 patients (5.06%) undergoing nephrectomy developed chyle leak. One out of these eight patients underwent nephrectomy by open approach while seven underwent laparoscopic approach. All eight patients who had chyle leak undergone left sided nephrectomy. Six patients of chyle leak could be managed with dietary modification while two patients needed octreotide therapy for treatment. Higher Body Mass Index (BMI; p-value = 0.012), left sides nephrectomy ( p-value = 0.013), h/o pyelonephritis ( p-value = 0.005) were associated with higher incidence of chyle leak on univariate analysis. While on multivariate analysis no factor was found to be independently associated with chyle leak. Hospital stay was significantly prolonged in patients with chyle leak ( p-value = 0.007). Conclusion: Chyle leak is not a very rare complication after nephrectomy. Patients with higher BMI, who undergo left sided nephrectomies and patients who had history of pyelonephritis or infectious complications had higher incidence of chyle leak. Most cases can be managed with conservative management (CM). Chyle leak is associated with a prolonged hospital stay.

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Octreotide/orlistat

2021

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A rare complication after laparoscopic donor nephrectomy: Chyle leak - A case report

Cited by 5 publications

References 4 publications

Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report

Post-operative chyle leak following nephrectomy: Inference from tertiary care center and review of literature

Octreotide/orlistat

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