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Chylous Ascites

Complication of Laparoscopic Donor Nephrectomy. Case Report and Review of Literature

Seth, Abhinav, MS General Surgery1; Sharma, Ashish, MS General Surgery1; Kenwar, Deepesh Benjamin, MS General Surgery1; Singh, Sarbpreet, MS General Surgery1

doi: 10.1097/TP.0000000000002514
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Background. Chylous ascites (CA) is an extremely rare complication after laparoscopic donor nephrectomy (LDN). It can increase the hospital stay, morbidity in postoperative period and thus negating the benefits of laparoscopic surgery. Most of the cases were managed conservatively, but surgical intervention may be occasionally required. This report describes the importance of accurate localization of the leaking chyle duct and its repair by endosuturing in a renal donor not responding to conservative treatment.

Methods. A comprehensive review of literature regarding this rare complication after LDN was performed with Pubmed/Medline and Google Scholar using “chyle,” “complications,” and “laparoscopic donor nephrectomy” as keywords. The demographic profile and management of patients is discussed in detail. The various surgical modalities used to manage these patients are described.

Results. Fifty-four cases of chyle leak/ascites have been reported after LDN in literature to date. Around 77% donors with CA could be successfully managed conservatively with dietary measures and total parenteral nutrition. Surgical intervention was required in nearly 23% donors ranging from clip application, use of argon coagulation, endosuturing with application of glue after 36.1 ± 19.07 days of failed conservative treatment. Donors with massive ascites or requiring frequent large-volume paracentesis on conservative treatment are likely to require surgical therapy. The present case was successfully managed with laparoscopic endosuturing and has no recurrence at 6 month follow-up.

Conclusions. Chylous ascites is a rare complication after donor nephrectomy in experienced centers. Although conservative management remains the first line of treatment, early surgical treatment shall be undertaken in cases of massive ascites.

1 Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Received 31 July 2018. Revision received 8 October 2018.

Accepted 26 October 2018.

The authors declare no funding or conflicts of interests.

Ab.S., As.S., D.B.K., S.S. participated in research design, writing of the article and data analysis. As.S. participated in research design, writing of the article and data analysis. D.B.K. participated in research design. S.S. participated in the performance of the research.

Correspondence: Sarbpreet Singh, MS General Surgery, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector -12, Pin code: 160012, Chandigarh, India. (drsarbpreetsingh@yahoo.com).

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