Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Langenbecks Arch Surg. 2020 Nov;405(7):1017-1024. doi: 10.1007/s00423-020-01938-4. Epub 2020 Jul 20.

Abstract

Background: We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect.

Methods: Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure.

Results: In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19).

Conclusions: Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.

Keywords: Chylous ascites; D3 extended mesenterectomy; Fat-free diet; Fat-reduced diet; Lymphatic leak.

MeSH terms

  • Abdomen
  • Chylous Ascites* / epidemiology
  • Chylous Ascites* / etiology
  • Chylous Ascites* / prevention & control
  • Colectomy / adverse effects
  • Drainage
  • Humans
  • Length of Stay