ReviewTreatment options for chylous ascites after major abdominal surgery: a systematic review

- Postoperative chylous ascites represents a relevant economic problem, especially in oncologic surgery.
- Extensive lymphadenectomies and lymphatic tissue dissections increase the risk.
- Conservative treatment is highly effective in resolving chylous ascites.

BackgroundChylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay.Data sourcesA systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement. The search for the MeSH terms “chylous ascites” and/or “lymphatic fistula” retrieved a total of 2,348 articles, of which 36 full-text articles were reviewed by 2 independent investigators.ResultsChylous ascites is described with an incidence of up to 11%, especially after pancreatic surgery. The incidence is increasing with the number of lymph nodes harvested. In patients treated with total parenteral nutrition, conservative treatment is demonstrated to be effective in up to 100% of cases.ConclusionsThe extent of abdominal surgery mainly predicts the risk of chylous ascites. Conservative treatment has been shown to be effective in almost all cases and is the treatment of choice.