title: Chylous Ascites Management After Pancreatic Surgery.
abstract: Postoperative chylous ascites (CA) following pancreatic surgery is uncommon. If left untreated, it leads to malnutrition, immunodeficiency and increased postoperative morbidity and mortality. The aim of this study was to seek out risk factors associated with CA onset and conservative treatment (CT) failure in order to determine better management of CA following pancreatic resection.
  
  
  
  All consecutive patients who underwent pancreatic surgery between 2004 and 2014 were reviewed retrospectively. Main demographic, clinical and pathological data were searched for CA risk factors. Patients with CA successfully treated with CT alone were compared to those requiring additional bipedal lymphangiography (BPLAG) in order to seek out risk factors associated with CT failure.
  
  
  
  Fifteen patients (2.4 %) developed CA after pancreatic surgery. Para-aortic lymph node sampling and early enteral feeding were found to be independent risk factors for postoperative CA (OR 6.36, p = 0.024 and OR 12.18, p = 0.02, respectively). CT was successful in ten patients, and five patients required additional BPLAG to achieve CA resolution. Statistical analysis revealed no significant risk factors for CT failure, including total lymph node count (p = 0.196), para-aortic lymph node sampling (p = 0.661) or maximum chyle loss per day (p = 0.758).
  
  
  
  Owing to postoperative CA rarity, there is no consensus in treatment. Early on, CT should be attempted in all patients with CA. BPLAG is a safe and efficient procedure that should be discussed earlier in the step-up therapeutic management.
authors: Centre Hospitalier Universitaire de Nantes, Nantes, France. nicolastabchouri@gmail.com.
authors: Nicolas
authors: N
authors: Tabchouri
authors: Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors: Eric
authors: E
authors: Frampas
authors: Centre Hospitalier Regional Universitaire de Tours, Tours, France.
authors: Frederic
authors: F
authors: Marques
authors: Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors: Claire
authors: C
authors: Blanchard
authors: Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors: Adam
authors: A
authors: Jirka
authors: Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors: Nicolas
authors: N
authors: Regenet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002915:Chylous Ascites / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors