title: Treatment options for chylous ascites after major abdominal surgery: a systematic review.
abstract: BACKGROUND
  Chylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Chylous 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Weniger
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
authors.forename: Jan G
authors.initials: JG
authors.lastname: D'Haese
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany. Electronic address: martin.angele@med.uni-muenchen.de.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistraße 15, Munich, D-81377, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002915:Chylous Ascites / Q000209:etiology / Q000628:therapy*; D005402:Fistula / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008206:Lymphatic Diseases / Q000209:etiology / Q000628:therapy*; D010180:Pancreatectomy; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000628:therapy*; D016896:Treatment Outcome
keywords: Lymph fistula; Medium chain triglyceride diet; Octreotide; Pancreatic surgery; Total parenteral nutrition