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chylous ascites in colorectal surgery:A systematic review

World Journal of Gastrointestinal Surgery 2021年第6期13卷 585-596页

作者： Zi Qin Ng Margaret Han Han Nien Beh Simon Keelan Department of General Surgery St John of God Midland HospitalMidland 6056Western AustraliaAustralia Department of General Surgery Joondalup Health CampusJoondalup 6027Western AustraliaAustralia

BACKGROUND chylous ascites is a rare complication in colorectal surgery with limited *** To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and management *** The systematic review was performed through PubMed,MEDLINE,EMBASE and Cochrane and cross-checked up to November *** data collated included:Demographics,indications(benign vs malignant),site of disease,surgical approach,extent of lymphadenectomy,day to and method of diagnosis of chylous ascites and management *** A total of 28 studies were included in the final analysis(426 cases).Patient age ranged from 31 to 89 *** except one case were performed for *** the 426 cases,195 were right-colonic,121 left-colonic,103 pelvic surgeries and 7 *** majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased *** cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent *** cases were managed successfully non-operatively(fasting with prolonged drainage,total parenteral nutrition,somatostatin analogues or a combination of these).Only three cases required surgical intervention after failing conservative management and subsequently resolved *** factors identified include:Right-colonic surgery/tumour location,extent of lymphadenectomy and number of lymph nodes *** chylous ascites after colorectal surgery is a relatively rare *** the majority of cases resolved without surgical intervention,preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.

关键词： chylous Chyle Ascites Leak Colon Rectum Lymphadenectomy

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Impact of chylous Ascites on Colon Cancer in Laparoscopic Surgery

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Open Journal of Gastroenterology 2018年第7期8卷 269-274页

作者： Shinya Munakata Kazuhiro Sakamoto Kumpei Honjo Masaya Kawai Kiichi Sugimoto Masakazu Ouchi Makoto Takahashi Yutaka Kojima Kunihiko Nagakari Yuichi Tomiki Department of Coloproctological Surgery Juntendo University Faculty of Medicine Tokyo Japan

Objectives: To investigate the epidemiology and risk factors of chylous ascites. Methods: We identified the cases of 913 consecutive patients who underwenturgery for colorectal cancerat our University Hospital between January 2005and December2016. We divided the patients into thosewith and those without chylous ascites and compared the two groups by age, gender, body mass index, tumor location, T, N factor, stage, operation time, intra-operative bleeding, and duration of postoperative hospital stay. Results: chylous ascites developed in 8 of the 913 patients (0.8%). Neither age, sex, tumor location, and body mass indexnor number of lymph nodeswereassociated with postoperative chylous ascites. Ascites occurred significantly less frequently in the early stage of colorectal cancer than in the late stage (p = 0.04). There was no significant difference between the groups in operative factors, including operation time and blood loss. Postoperative hospital stays were longer in patients with chylous ascites (20.5 days) than in those without (11 days) (p = 0.02). Conclusions: Late stage was one of the risk factors for chylous ascites in the present study. Other risks, such as tumor location and blood loss,will vary from institution to institution.

关键词： chylous Ascites Colon Cancer Epidemiology Laparoscopic Surgery Risk Factor

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Surgical repair of intractable chylous ascites following laparoscopic anterior resection

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World Journal of Gastroenterology 2015年第19期21卷 6077-6081页

作者： Gi Won Ha Min Ro Lee Research Institute of Clinical Medicine Chonbuk National University Medical School

chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides and it is an unusual complication following surgical treatment of colorectal cancer. Conservative management is usually sufficientin patients with chylous ascites after surgery. However,we describe a patient with intractable chylous ascites after laparoscopic anterior resection for sigmoid colon cancer who failed initial conservative treatment. This patient was successfully managed by surgery.

关键词： Sigmoid colon cancer Laparoscopy Anteriorresection chylous ascites Surgical repair

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chylous ascites in laparoscopic renal surgery: Where do we stand?

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World Journal of Clinical Urology 2016年第1期5卷 37-44页

作者： Bum Soo Kim Tae Gyun Kwon Department of Urology Kyungpook National University Hospital Kyungpook National University School of Medicine Department of Urology Chilgok Kyungpook National University Hospital Kyungpook National University School of Medicine

Postoperative chylous ascites, which is caused by the disruption of lymphatic channels and persistent lymphatic leakage, was a rare complication in the urologic field before laparoscopic surgery was introduced. Now that laparoscopic urologic surgery, especially laparoscopic nephrectomy, is widely performed, chylous ascites as a complication of laparoscopic renal surgery has been reported more frequently. With these accumulated experiences and data comes knowledge about the proper diagnosis and management of chylous ascites, although there is still some debate regarding the correct protocol for diagnosis and management. Therefore, we performed a systematic review of the current literature regarding the etiology, incidence, diagnosis, management, and prognosis of chylous ascites after laparoscopic renal surgery, as well as strategies used to prevent it, and discuss current perspectives on overcoming this complication in the laparoscopic age.

关键词： chylous ascites Kidney Laparoscopy Nephrectomy Postoperative complications

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Non chylous filarial ascites: A rare case report

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World Journal of Clinical Infectious Diseases 2015年第1期5卷 11-13页

作者： Kaivan S Shah Prasad A Bhate Dattatray Solanke Vikas Pandey Meghraj A Ingle Shubhada V Kane Prabha Sawant Department Of Gastroenterology LTMMC and LTMGH Sion HospitalSion West Mumbai 400022 India

Filariasis is a common health problem in tropical and subtropical regions including India. It commonly presents with lymphatic involvement in form of nonpitting pedal edema, chylous ascites, chyluria,hydrocele and lymphocele. Detection of microfilaria in ascitic fluid is an extremely uncommon finding. We present a case of non chylous ascites where microfilaria were detected in the ascitic fluid.

关键词： Microfilaria Postpartum ascites Non chylous ascites

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Changes over time in milk test results following pancreatectomy

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World Journal of Gastrointestinal Surgery 2016年第3期8卷 246-251页

作者： Hideki Aoki Masashi Utsumi Kenta Sui Nobuhiko Kanaya Tomoyoshi Kunitomo Hitoshi Takeuchi Norihisa Takakura Shigehiro Shiozaki Hiroyoshi Matsukawa Department of Surgery Iwakuni Clinical Center Department of Surgery Fukuyama City Hospital Department of Surgery Hiroshima City Hospital

AIM: To investigate changes over time in, and effects of sealing technology on, milk test results following pancreatectomy. METHODS: From April 2008 to October 2013, 66 pancreatic resections were performed at the Iwakuni Clinical Center. The milk test has been routinely conducted at the institute whenever possible during pancreatectomy. The milk test comprises the following procedure: A nasogastric tube is inserted until the third portion of the duodenum, followed by injection of 100 mL of milk through the tube. If a chyle leak is present, the patient tests positive in this milk test based on the observation of a white milky discharge. Positive milk test rates, leakage sites, and chylous ascites incidence were examined. Liga Sure?(LS; Covidien, Dublin, Ireland), a vessel-sealing device, is routinely used in pancreatectomy. Positive milk test rates before and after use of LS, as well as drain discharge volume at the 2^(nd) and 3^(rd) postoperative days, were compared retrospectively. Finally, positive milk test rates and chylous ascites incidence were compared with the results of a previous ***: Fifty-nine milk tests were conducted during pancreatectomy. The positive milk test rate for all pancreatectomy cases was 13.6%(8 of 59 cases). One case developed postoperative chylous ascites(2.1% among the pancreatoduedenectomy cases and 1.7% among all pancreatectomies). Positive rates by procedure were 12.8% for pancreatoduodenectomy and 22.2% for distal pancreatectomy. Positive rates by disease were 17.9% for pancreatic and 5.9% for biliary diseases. When comparing results from before and after use of LS, positive milk test rates in pancreatoduodenectomy were 13.0% before and 12.5% after, while those in distal pancreatectomy were 33.3% and 0%. Drainage volume tended to decrease when LS was used on the 3^(rd) postoperative day(volumes were 424 ± 303 mL before LS and 285 ± 185 mL after, P = 0.056). Both chylous ascites incidence and positive milk test rates decrea

关键词： chylous ascites Milk test Pancreatectomy Surgical energy device Drain discharge

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