title: Changes over time in milk test results following pancreatectomy.
abstract: OBJECTIVE
  To investigate changes over time in, and effects of sealing technology on, milk test results following pancreatectomy.
  
  
  METHODS
  From April 2008 to October 2013, 66 pancreatic resections were performed at the Iwakuni Clinical Center. The milk test has been routinely conducted at the institute whenever possible during pancreatectomy. The milk test comprises the following procedure: A nasogastric tube is inserted until the third portion of the duodenum, followed by injection of 100 mL of milk through the tube. If a chyle leak is present, the patient tests positive in this milk test based on the observation of a white milky discharge. Positive milk test rates, leakage sites, and chylous ascites incidence were examined. LigaSure™ (LS; Covidien, Dublin, Ireland), a vessel-sealing device, is routinely used in pancreatectomy. Positive milk test rates before and after use of LS, as well as drain discharge volume at the 2(nd) and 3(rd) postoperative days, were compared retrospectively. Finally, positive milk test rates and chylous ascites incidence were compared with the results of a previous report.
  
  
  RESULTS
  Fifty-nine milk tests were conducted during pancreatectomy. The positive milk test rate for all pancreatectomy cases was 13.6% (8 of 59 cases). One case developed postoperative chylous ascites (2.1% among the pancreatoduedenectomy cases and 1.7% among all pancreatectomies). Positive rates by procedure were 12.8% for pancreatoduodenectomy and 22.2% for distal pancreatectomy. Positive rates by disease were 17.9% for pancreatic and 5.9% for biliary diseases. When comparing results from before and after use of LS, positive milk test rates in pancreatoduodenectomy were 13.0% before and 12.5% after, while those in distal pancreatectomy were 33.3% and 0%. Drainage volume tended to decrease when LS was used on the 3(rd) postoperative day (volumes were 424 ± 303 mL before LS and 285 ± 185 mL after, P = 0.056). Both chylous ascites incidence and positive milk test rates decreased slightly compared with those rates from the previous study.
  
  
  CONCLUSIONS
  Positive milk test rates and chylous ascites incidence decreased over time. Sealing technology may thus play an important role in preventing postoperative chylous ascites.
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Utsumi
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Sui
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kanaya
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Kunitomo
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Takakura
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Shiozaki
authors.affiliation: Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Department of Surgery, Iwakuni Clinical Center, Iwakuni 7408510, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Matsukawa
keywords: Chylous ascites; Drain discharge; Milk test; Pancreatectomy; Surgical energy device