title: Management and prevention of chylous leakage after laparoscopic lymphadenectomy.
abstract: OBJECTIVE
  To investigate the development and management of chylous leakage after laparoscopic retroperitoneal lymphadenectomy.
  
  
  METHODS
  From July 2006 to September 2013, 13 cases of chylous leakage after the laparoscopic lymphadenectomy (6 cases of renal cell carcinoma, 4 cases of gastric cancer, 2 cases of ovarian cancer, 1 case of endometrial cancer) were studied to analyze the occurrence, development and management of chylous leakage.
  
  
  RESULTS
  In 3 cases (2 cases of renal cell carcinoma, 1 case of gastric cancer) massive amount of milky fluid drainage was be seen after the first two days post operation. Dietary intervention, TPN (total parenteral nutrition), somatostatin therapy, maintenance of continuous drainage helped to successfully manage the condition in about 1 month duration. In the remaining 10 cases, chylous leakage appeared after restoring normal diet. Managed with changes in diet and maintenance of unobstructed drainage, they were cured in about 2 weeks after treatment. There was significant reduction in drain output, ultrasonography did not reveal presence of free fluid collection in abdomen, and the patients were in good condition without signs and symptoms of infections.
  
  
  CONCLUSIONS
  Chylous leakage is a rare complication of retroperitoneal lymph node dissection. Surgeons should be familiar with laparoscopic techniques, relevant anatomy and be aware of the fact that the effect of CO2 pressure and use of ultrasonic knife to occlude the lymphatic vessel can transiently block the leakage making the surgeon overlook them. Routine placement of indwelling drainage tube, immediate diagnosis, dietary modification, TPN, somatostatin and drainage are the modalities of conservative management.
authors.affiliation: Department of Obstetrics and Gynecology, Department of Gastrointestinal Surgery, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China. lipinghancn@163.com.
authors.forename: L-P
authors.initials: LP
authors.lastname: Han
authors.forename: H-M
authors.initials: HM
authors.lastname: Zhang
authors.forename: H-D
authors.initials: HD
authors.lastname: Abha
authors.forename: T
authors.initials: T
authors.lastname: Liu
authors.forename: X-P
authors.initials: XP
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002915:Chylous Ascites / Q000517:prevention & control* / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery