title: Incidence, diagnosis, and treatment of chylous leakage after laparoscopic live donor nephrectomy.
abstract: BACKGROUND
  Chylous leakage (CL) is a rare complication of laparoscopic live donor nephrectomy (LLDN). It may lead to malnutrition and immunological deficits because of protein and lymphocyte depletion.
  
  
  METHODS
  Data from 208 consecutive LLDN performed at two institutions, between April 2000 and September 2010, were reviewed to identify the anatomical basis behind CL along with its diagnostic and therapeutic options.
  
  
  RESULTS
  CL developed in eight donors (3.8%), as determined by high-volume drainage (range 540-800 mL/24 hr) of triglyceride-rich fluid. All donors were managed conservatively. Seven were put on total parenteral nutrition plus octreotide. One received low-fat diet, medium-chain triglyceride supplementation, and octreotide. Chylous fistulas resolved in 5 to 16 days (mean time 12.3 days). Drains were removed before hospital discharge, and no donor was readmitted and/or needed outpatient care.
  
  
  CONCLUSIONS
  CL is a potentially insidious and perhaps misdiagnosed complication after LLDN. It occurs in nearly 4% of LLDN and it seems to be uniquely associated to left-sided kidney recovery because of distinctive lymphatics distribution around the periaortic area of dissection. Conservative therapy is effective in most donors and should be initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory CL before the arising of malnutrition and/or relevant immunodeficiency.
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgical Sciences, Parma University Hospital, Parma, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Capocasale
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iaria
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Signori
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Mazzoni
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dalla Valle
authors.forename: Nelide
authors.initials: N
authors.lastname: De Lio
authors.forename: Vittorio
authors.initials: V
authors.lastname: Perrone
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
mesh_terms: D000328:Adult; D002915:Chylous Ascites / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D004322:Drainage; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D015282:Octreotide / Q000627:therapeutic use; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000032:analysis
chemical_list: D005765:Gastrointestinal Agents; D014280:Triglycerides; D015282:Octreotide