title: Chylous ascites after hepatopancreatobiliary surgery.
abstract: BACKGROUND
  Postoperative chylous ascites following abdominal surgery is uncommon. It potentially induces malnutrition and immunodeficiency, contributing to increased mortality. In the field of hepatopancreatobiliary (HPB) surgery, no large studies have been conducted that focused on postoperative chylous ascites. The aim of this study was to determine the incidence, risk factors and management of chylous ascites following HPB surgery, with particular emphasis on pancreatic resection.
  
  
  METHODS
  Consecutive patients who had HPB surgery between 2000 and 2011 at a single institution were reviewed retrospectively. Chyle leak was defined as 100 ml/day or more of milky, amylase-free peritoneal fluid with a triglyceride concentration of 110 mg/dl or above. Risk factors for chylous ascites associated with pancreatic resection and the clinical efficacy of octreotide in treating chylous ascites were evaluated.
  
  
  RESULTS
  Of 2002 consecutive patients who underwent HPB surgery during the study period, 21 (1·0 per cent) developed chylous ascites. Chylous ascites occurred relatively frequently in patients who had a pancreatic resection, such as pancreaticoduodenectomy (3·3 per cent) or distal pancreatectomy (3·8 per cent). Multivariable analysis revealed that manipulation of the para-aortic area (P < 0·001), retroperitoneal invasion (P = 0·031) and early enteral feeding after operation (P < 0·001) were independent risk factors for chylous ascites following pancreatic resection. Octreotide treatment decreased drainage output of chylous ascites on day 1 after initiation of treatment (P = 0·002).
  
  
  CONCLUSIONS
  Chylous ascites is a rare complication following HPB surgery. It is more common after pancreatic resection. Treatment with octreotide combined with total parenteral nutrition is recommended.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kuboki
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Yoshidome
authors.forename: M
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: A
authors.initials: A
authors.lastname: Kato
authors.forename: H
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: K
authors.initials: K
authors.lastname: Furukawa
authors.forename: M
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D001660:Biliary Tract Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D002915:Chylous Ascites / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide