Conservative management of chylous leak after open radical nephrectomy in an adult patient: a case report and literature review

Alrabadi, Adel; Ihmeidan, Mohammad; Demour, Saddam Al

doi:10.1186/s12301-020-00116-8

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Many centers routinely advocate for drain placement, while others do not. 3,9 This discrepancy may be the reason for having more cases of chylous ascites (CA) in follow-up. Once a normal diet is resumed, fats and lipid content are absorbed in the intestine.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…[4] Several reports of chyle leak after nephrectomy reported complete resolution with one or some combination of these interventions. [5,6] Paracentesis is also commonly utilized in treatment for both diagnostic and therapeutic purposes. [4] However, repeat paracentesis is associated with its own risks that can further complicate one's clinical course, including malnutrition and infection.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy

Hargis

Henslee

Pokala

et al. 2021

JCIS

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To propose minimally invasive percutaneous techniques in the management of high output chylous ascites, a known potential complication of retroperitoneal surgery associated with significant morbidity and mortality. Management has traditionally been based on successful treatment reported in the literature. However, refractory or high-output leaks often prove difficult to treat and there is little evidence on superior management. We report percutaneous maceration and embolization for the management of high-volume abdominal chyle leak after robot-assisted laparoscopic (RAL) radical nephrectomy and lymph node dissection for renal cell carcinoma. A 68-year-old male with incidentally found renal cell carcinoma underwent RAL radical nephrectomy with paraaortic lymph node dissection. He initially improved after surgery but developed significant abdominal pain and distension approximately 7 weeks postoperative. This proved to be chyloperitoneum. Conservative management was initiated, but after continued high-output (>1 L) fluid drainage, we pursued adjunct intervention involving Interventional Radiological percutaneous procedures. This included lymphatic maceration and glue embolization of leaking lymphatics. The patient tolerated the percutaneous procedures well with significant improvement in drain output ultimately leading to complete resolution of ascites without further complication. Similar interventions have previously been reported in the literature for cases of chylothorax with success. However, there is a lack of reports on utilizing this minimally invasive procedure for chyloperitoneum after retroperitoneal urologic surgery. We report our successful experience with percutaneous lymphatic maceration and embolization for high output chylous ascites after RAL radical nephrectomy with lymphadenectomy. We believe that early initiation utilizing these percutaneous techniques can achieve timely resolution and should be considered in the management of these patients.

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Chylous ascites following laparoscopic donor nephrectomy: Report of a case and a brief overview

Sheela¹,

Thomas²,

Yadav³

et al. 2023

Indian J Transplant

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Conservative management of chylous leak after open radical nephrectomy in an adult patient: a case report and literature review

Cited by 3 publications

References 18 publications

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

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

Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy

Chylous ascites following laparoscopic donor nephrectomy: Report of a case and a brief overview

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