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THE DIAGNOSIS AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITES

2002; Lippincott Williams & Wilkins; Volume: 167; Issue: 2 Part 1 Linguagem: Inglês

10.1016/s0022-5347(01)69064-5

1527-3792

Ilan Leibovitch, Yoram Mor, Jacob Golomb, Jacob Ramon,

Vascular Malformations and Hemangiomas

No AccessJournal of UrologyCLINICAL UROLOGY: Review Article1 Feb 2002THE DIAGNOSIS AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITES ILAN LEIBOVITCH, YORAM MOR, JACOB GOLOMB, and JACOB RAMON ILAN LEIBOVITCHILAN LEIBOVITCH More articles by this author , YORAM MORYORAM MOR More articles by this author , JACOB GOLOMBJACOB GOLOMB More articles by this author , and JACOB RAMONJACOB RAMON More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)69064-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Postoperative chylous ascites is a rare complication of retroperitoneal and mediastinal surgery that represents a difficult management problem due to the serious mechanical, nutritional and immunological consequences of the constant loss of protein and lymphocytes. We reviewed the topic of postoperative chylous ascites with special emphasis on the relevant diagnostic and imaging modalities. We propose a novel management algorithm. Materials and Methods: We performed a MEDLINE search of the literature on chylous ascites using chyloperitoneum as the subject heading and chylous ascites as an additional key word. The search yielded 651 articles. We focused on 102 series, collective reviews and mainly case reports related to the issue of postoperative chylous ascites. Results: We propose a novel algorithm based on a step-up approach aimed at promoting decreased lymph production and flow as well as maintaining nutritional balance. The management algorithm integrates repeat palliative paracentesis, dietary measures, total parenteral nutrition therapy, peritoneovenous shunting and surgical closure of the lymphoperitoneal fistula. Due to the remarkable effectiveness of somatostatin therapy for 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 any invasive steps are taken. Conclusions: Various management modalities may be used successfully to treat chylous ascites. Therefore, treatment should be individualized and adjusted to the severity of lymphatic leakage and its consequences. The outcome mostly depends on the underlying pathological condition. Thus, in the absence of malignant or congenital underlying pathology the prognosis in cases of postoperative chylous ascites is good with the majority responding to conservative measures. References 1 : Aetiology and treatment of chylous ascites. Br J Surg1992; 79: 1145. Google Scholar 2 : Rapid resolution of chylous ascites after liver transplantation using somatostatin analog and total parenteral nutrition. Transplantation1996; 61: 1410. 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Google Scholar From the Department of Urology, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRose K, Huelster H, Roberts E, Manley B, Gilbert S and Sexton W (2022) Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment AlgorithmJournal of Urology, VOL. 208, NO. 1, (53-61), Online publication date: 1-Jul-2022.Yarmohammadi H, Schilsky J, Durack J, Brody L, Asenbaum U, Velayati S, Santos E, Gonzalez-Aguirre A, Erinjeri J, Petre N, Solomon S, Sheinfeld J and Getrajdman G (2020) Treatment of Chylous Ascites with Peritoneovenous Shunt (Denver Shunt) following Retroperitoneal Lymph Node Dissection in Patients with Urological Malignancies: Update of Efficacy and Predictors of ComplicationsJournal of Urology, VOL. 204, NO. 4, (818-823), Online publication date: 1-Oct-2020.Kim B, Yoo E, Kim T and Kwon T (2010) Chylous Ascites as a Complication of Laparoscopic NephrectomyJournal of Urology, VOL. 184, NO. 2, (570-574), Online publication date: 1-Aug-2010.Khorrami M, Salehi P, Nouri-Mahdavi K, Ghalamkari A and Tadayyon F (2008) Dramatic Effect of a Somatostatin Analogue in Decreasing Mucus Production by the Intestinal Segment After EnterocystoplastyJournal of Urology, VOL. 180, NO. 6, (2501-2503), Online publication date: 1-Dec-2008.MOLINA W, DESAI M and GILL I (2018) Laparoscopic Management of Chylous Ascites After Donor NephrectomyJournal of Urology, VOL. 170, NO. 5, (1938-1938), Online publication date: 1-Nov-2003.WEISER A, LINDGREN B, RITCHEY M and FRANCO I (2018) Chylous Ascites Following Surgical Treatment for Wilms TumorJournal of Urology, VOL. 170, NO. 4 Part 2, (1667-1669), Online publication date: 1-Oct-2003. Volume 167Issue 2 Part 1February 2002Page: 449-457 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordstestiskidneysomatostatinpostoperative complicationschyloperitoneumMetricsAuthor Information ILAN LEIBOVITCH More articles by this author YORAM MOR More articles by this author JACOB GOLOMB More articles by this author JACOB RAMON More articles by this author Expand All Advertisement PDF downloadLoading ...