Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery

Strobel, Oliver; Brangs, S; Hinz, Ulf; Pausch, Thomas; Hüttner, Felix J; Diener, Markus K.; Schneider, Lutz; Hackert, Thilo; Büchler, Markus W.

doi:10.1002/bjs.10316

Cited by 44 publications

(54 citation statements)

References 18 publications

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“…These structures may be injured during pancreaticoduodenectomy (PD), resulting in chyle leakage, which is a well‐known but poorly characterized complication of PD . This chyle leakage often presents as milky‐appearing drainage outflow, with a triglyceride content >110 mg/dL and usually becomes evident once oral or enteral feeding resumes after surgery . Chyle leakage might induce malnutrition and lead to an immune‐compromised state .…”

Section: Introductionmentioning

confidence: 99%

“…This chyle leakage often presents as milky‐appearing drainage outflow, with a triglyceride content >110 mg/dL and usually becomes evident once oral or enteral feeding resumes after surgery . Chyle leakage might induce malnutrition and lead to an immune‐compromised state . Available data on the incidence, risk factors, and clinical significance of chyle leakage are heterogeneous .…”

Section: Introductionmentioning

confidence: 99%

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Chyle leakage after robotic and open pancreaticoduodenectomy

Shyr

Chen

et al. 2020

J Hepato Biliary Pancreat

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Background: Chyle leakage is a well-known but poorly characterized complication after pancreaticoduodenectomy (PD). No study examined the chyle leakage after robotic PD (RPD). Methods: Data regarding chyle leakage were prospectively collected and analyzed from patients undergoing RPD or open PD (OPD). Results: The study included 118 RPD and 165 OPD. Overall chyle leakage rate was 12.0%, with 13.6% for RPD and 10.9% for OPD. Chyle leakage was eventually resolved in all patients through conservative treatment. The drainage volumes were significantly higher in chyle leakage group from postoperative days (PODs) 1-7, with a median of 240 mL on POD 1 and POD 7, as compared to 160 mL on POD 1 and 70 mL on POD 7 for those without chyle leakage. The number of lymph nodes involved and resected and pancreatic head adenocarcinoma affected the risk of developing chyle leakage, whereas the surgical approach used (RPD or OPD) did not. Conclusions: Chyle leakage after PD is not rare, and it can eventually be resolved through conservative treatment. The extent and radicality of the surgery probably have a significant effect on the risk of developing chyle leakage, but the surgical approach used does not. K E Y W O R D S chyle, leakage, open, pancreaticoduodenectomy, robotic

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chyle leakage after robotic and open pancreaticoduodenectomy

Shyr

Chen

et al. 2020

J Hepato Biliary Pancreat

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show abstract

“…It could be in isolation as observed by us or in association with other common postpancreatectomy complications. Strobel et al, in their experience of 346 patients with chylous leak among 2881 patients undergoing pancreatic resection, reported an isolated chyle leak in 211 (11.1%) patients without concomitant intra‐abdominal complications and in the remaining 135 (13.8%) patients with other intra‐abdominal complications, that is, pancreatic fistula and intra‐abdominal abscess. van der Gaag et al pointed out that the surrounding inflammation and head mass with reactive lymph nodes induced by chronic pancreatitis require more extensive dissection, leading to chyle leak.…”

Section: Discussionmentioning

confidence: 99%

“…No patient required TPN or surgical treatment. Strobel et al managed 346 patients with chylous ascites with or without associated intra‐abdominal complications following pancreatic resection and concluded that all patients responded to combinations of MCT, TPN, and somatostatin. In our experience as well, all patients were successfully managed with customized enteral feeding of a high‐protein, low‐fat diet administered through a feeding jejunostomy or nasogastric tube along with supportive treatment.…”

Section: Discussionmentioning

confidence: 99%

Management of chylous ascites following pancreaticobiliary surgery

et al. 2019

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Background Chyle leak is an uncommon form of ascites occurring due to the accumulation of lipid‐rich lymph into the peritoneal cavity. Traumatic injury to the lymphatic system due to pancreaticobiliary surgery can lead to this phenomenon. Method We retrospectively evaluated the data of 159 patients of pancreticobiliary surgery from January 2012 to December 2016. Five patients (5/137, 3.6%) sustained a chylous leak following pancreaticoduodenectomy and one patient (1/22, 4.5%) sustained a chylous leak following Roux‐en‐Y hepaticojejunostomy for postcholecystectomy biliary stricture. Results Average daily output was 441 mL (range: 150–800 mL/day), and total duration of output was 16.5 days (range: 4–35 days). Mean hospital stay increased to 19.1 days (range: 10–40 days). All the patients were successfully managed conservatively with a combination of customized enteral feeds, supplemental parenteral nutrition, and octreotide. One patient required additional percutaneous drainage. Conclusion Chyle leak can be successfully treated with conservative management but at the cost of increased hospital stay.

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“…Chyle leak is an important complication after pancreatic surgery which could be relevant to the present model because chyle contains triglycerides. Recently, chyle leak was found to be significantly associated with POPF. The major contents of chyle are not free triglycerides but chylomicron, which is a combination of lipoproteins and triglycerides, and pancreatic lipase cannot catalyse lipids within lipoproteins.…”

Section: Discussionmentioning

confidence: 99%

Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery

Uchida

Masui

Nakano

et al. 2019

British Journal of Surgery

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Background: Visceral obesity is one of the risk factors for clinically relevant pancreatic fistula after pancreatic resection. The objective of this study was to evaluate the impact of intraperitoneal lipolysis on postoperative pancreatic fistula.Methods: The degree of intraperitoneal lipolysis was investigated by measuring the free fatty acid concentration in drain discharge in patients after pancreatic resection. An experimental pancreatic fistula model was prepared by pancreatic transection, and the impact of intraperitoneal lipolysis was evaluated by intraperitoneal administration of triolein (triglyceride) with, or without orlistat (lipase inhibitor).Results: Thirty-three patients were included in the analysis. The free fatty acid concentration in drain discharge on postoperative day 1 was significantly associated with the development of a clinically relevant pancreatic fistula (P = 0⋅004). A higher free fatty acid concentration in drain discharge was associated with more visceral adipose tissue (P = 0⋅009). In the experimental model that included 98 rats, intraperitoneal lipolysis caused an increased amount of pancreatic juice leakage and multiple organ dysfunction. Intraperitoneal administration of a lipase inhibitor reduced lipolysis and prevented deterioration of the fistula. Conclusion: Intraperitoneal lipolysis significantly exacerbates pancreatic fistula after pancreatic resection. Inhibition of lipolysis by intraperitoneal administration of a lipase inhibitor could be a promising therapy to reduce clinically relevant postoperative pancreatic fistula. Surgical relevanceClinically, there are two types of pancreatic fistula after pancreatic resections: harmless biochemical leak and harmful clinically relevant pancreatic fistula. Visceral obesity is one of the known risk factors for clinically relevant pancreatic fistula; however, the underlying mechanisms remained to be elucidated.Patients with clinically relevant pancreatic fistula had a higher free fatty acid concentration in the drain discharge, suggesting a relationship between intraperitoneal lipolysis and pancreatic fistula. The experimental model of pancreatic fistula demonstrated that intraperitoneal lipolysis caused deterioration in pancreatic fistula, suggesting that intraperitoneal lipolysis is one of the mechanisms that drives biochemical leakage to clinically relevant pancreatic fistula.Intraperitoneal administration of a lipase inhibitor prevented lipolysis as well as pancreatic fistula deterioration in the experimental model, suggesting a future clinical application for lipase inhibitors in prevention of clinically relevant pancreatic fistula.

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Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery

Abstract: Chyle leak is a relevant complication, with an incidence of more than 10 per cent after pancreatic surgery, and has a major impact on hospital stay. Drainage volume is associated with hospital stay and success of therapy.

Cited by 44 publications

References 18 publications

Chyle leakage after robotic and open pancreaticoduodenectomy

Chyle leakage after robotic and open pancreaticoduodenectomy

Management of chylous ascites following pancreaticobiliary surgery

Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery

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