Treatment Options for Chylous Ascites After Major Abdominal Surgery: A Systematic Review

Am J Surg. 2016 Jan; 211(1):206-13. doi: 10.1016/j.amjsurg.2015.04.012. Epub 2015 Jun 3.
Weniger, M., D'Haese, J. G., Angele, M. K., Kleespies, A., Werner, J., & Hartwig, W.


Background: Chylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay.

Data sources: A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement. The search for the MeSH terms "chylous ascites" and/or "lymphatic fistula" retrieved a total of 2,348 articles, of which 36 full-text articles were reviewed by 2 independent investigators.

Results: Chylous ascites is described with an incidence of up to 11%, especially after pancreatic surgery. The incidence is increasing with the number of lymph nodes harvested. In patients treated with total parenteral nutrition, conservative treatment is demonstrated to be effective in up to 100% of cases.

Conclusions: The extent of abdominal surgery mainly predicts the risk of chylous ascites. Conservative treatment has been shown to be effective in almost all cases and is the treatment of choice.

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Reference work for leading, current and selected literature in the field of clinical nutrition

Publications on clinical nutrition have grown steadily in recent years and the scientific evidence has been improved by numerous observational as well as intervention studies. Various umbrella organisations, such as the Swiss Society for Clinical Nutrition (GESKES), the German Society for Nutritional Medicine (DGEM) or the European Society for Clinical Nutrition and Metabolism (ESPEN) publish guidelines on nutrition in various clinical situations at regular intervals. Thus, a large amount of literature is available for evidence-based nutritional medicine.

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List of abbreviations

DGEM German Society for Nutritional Medicine (German Deutsche Gesellschaft für Ernährungsmedizin)
GESKES  Swiss Society for Clinical Nutrition (German Gesellschaft für klinische Ernährung der Schweiz) 
ESPEN European Society of Clinicl Nutrition and Metabolism