Chylous Leakage After a Laparoscopic Live-Donor Nephrectomy: Case Report and Literature Review.
Laparoscopic donor nephrectomy is an established operation for organ procurement in living-donor transplant. Minimal access approach for organ procurement from living donors ensures early convalescence and improved patient participation. Chylous leakage is a rare complication of laparoscopic living-donor nephrectomy. Chylous leakage is mostly determined by iatrogenic injury of cisterna chyli and its main tributaries. It may lead to malnutrition and immunologic deficits because of protein and lymphocyte depletion. An 18-year-old woman underwent left-hand-assisted laparoscopic donor nephrectomy for living donor transplant. She developed chylosus leakage in third postoperative day. A conservative manage-ment with total parenteral nutrition total paren-teral nutrition and subcutaneous somatostatin was immediately initiated. The patient had an abatement of drainage daily output in 4 days of therapy. Chylous leakage is a potentially insidious and perhaps misdiagnosed complication of laparoscopic donor nephrectomy. Conservative therapy is effective in most donors and should be initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory chylous leakage before the arising of malnutrition and/or relevant immunodeficiency.
From the Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Universita di Roma, Policlinico Umberto I, Rome, Italy.
Nicola
N
Guglielmo
Fabio
F
Melandro
Francesco
F
Nudo
Gianluca
G
Mennini
Giovanni Battista
GB
Levi Sandri
Pasquale Bartolomeo
PB
Berloco
Massimo
M
Rossi
D000293:Adolescent; D002913:Chyle; D002915:Chylous Ascites / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects*; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D010289:Parenteral Nutrition, Total; D020127:Recovery of Function; D013004:Somatostatin / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D013004:Somatostatin