Chylous Ascites after Pancreaticoduodenectomy: Introduction of a Grading System

Milk-Based Test as a Preventive Method for Chylous Ascites following Pancreatic Resection

“…Large clinical studies have been conducted recently, however, especially of cases following pancreatic resection. According to such reports, rates of chylous ascites incidence after pancreatoduodenectomy ranged from 1.8 to 13% [9,10,11]. Our results indicated rates of 7.7% for all pancreatectomies and 5.0% for pancreaticoduodenectomies.…”

“…The reason why chyle leaks tend to be found a day or two after the start of postoperative oral intake is thus clear. Assumpcao et al [9] showed that the median time to chyle leak presentation following resection was 5 days (range 4–8) and van der Gaag et al [10] indicated a median time of 6 days (range 3–52). Both reports, however, failed to clarify the date of commencement of oral intake of meals.…”

“…However, van der Gaag et al [10] suggested that chronic pancreatitis at pathology was independently associated with development of isolated chylous ascites. One patient in our study was diagnosed with chronic pancreatitis.…”

“…In our study, all cases were treated with octreotide and total parenteral nutrition during a period of at least 1 week if chylous ascites had developed. Although van der Gaag et al [10] reported that octreotide, used as prophylaxis to prevent pancreatic leakage, was not a factor associated with prevention of chylous ascites development, Leibovitch et al [14] reviewed postoperative chylous ascites and concluded that due to its remarkable effectiveness in the closure of lymphatic fistula, somatostatin therapy should be attempted with or without total parenteral nutrition early in the course of treatment of chylous ascites before invasive steps are taken. As medium-chain triglycerides bypass the lymphatic glands, this therapy is effective for moderate chylous ascites and suggested as a maintenance measure even following treatment [14].…”

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

“…The lipid content of the enteral feed keeps open the visceral lymphatic channels that have been divided as part of the operative approach [2]. Chyle leak complicating pancreatic resection has previously been reported to occur in 1.3-10.8 % of cases [2,13,14]. In our series of 245 consecutive patients, 16.3 % of patients developed CL.…”