Skip to main content

Chyle Leak After Pancreatic Surgery

  • Chapter
  • First Online:
Textbook of Pancreatic Cancer

Abstract

During pancreatic resection lymph node dissection may be indispensable and chyle leak may occur as a postoperative complication. While uncertainty on its etiopathogenesis still persists, diagnosis and management have been recently standardized. Indeed, in 2017 the International Study Group of Pancreatic Surgery (ISGPS) released a consensus on definition and classification of this uncommon complication, identifying some therapeutic pathways that may help to speed up the healing process. In this book chapter the most relevant literature on the topic is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Browse NL, Wilson NM, Russo F, et al. Aetiology and treatment of chylous ascites. Br J Surg. 1992;79:1145–50. https://doi.org/10.1002/bjs.1800791110.

    Article  CAS  PubMed  Google Scholar 

  2. Loukas M, Wartmann CT, Louis RG Jr, et al. Cisterna chyli: a detailed anatomic investigation. Clin Anat. 2007;20:683–8. https://doi.org/10.1002/ca.20485.

    Article  PubMed  Google Scholar 

  3. Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156:591–600. https://doi.org/10.1016/j.surg.2014.06.016.

    Article  PubMed  Google Scholar 

  4. Besselink MG, van Rijssen LB, Bassi C, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the international study group on pancreatic surgery. Surgery. 2017;161:365–72. https://doi.org/10.1016/j.surg.2016.06.058.

    Article  PubMed  Google Scholar 

  5. Kuboki S, Shimizu H, Yoshidome H, et al. Chylous ascites after hepatopancreatobiliary surgery. Br J Surg. 2013;100:522–7. https://doi.org/10.1002/bjs.9013.

    Article  CAS  PubMed  Google Scholar 

  6. Strobel O, Brangs S, Hinz U, et al. Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery. Br J Surg. 2017;104:108–17. https://doi.org/10.1002/bjs.10316.

    Article  CAS  PubMed  Google Scholar 

  7. Assumpcao L, Cameron JL, Wolfgang CL, et al. Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg. 2008;12:1915–23. https://doi.org/10.1007/s11605-008-0619-3.

    Article  PubMed  Google Scholar 

  8. Paiella S, De Pastena M, Casciani F, et al. Chyle leak after pancreatic surgery: validation of the International Study Group of Pancreatic Surgery classification. Surgery. 2018;164:450–4. https://doi.org/10.1016/j.surg.2018.05.009.

    Article  PubMed  Google Scholar 

  9. Malik HZ, Crozier J, Murray L, et al. Chyle leakage and early enteral feeding following pancreatico-duodenectomy: management options. Dig Surg. 2007;24:418–22. https://doi.org/10.1159/000108324.

    Article  CAS  PubMed  Google Scholar 

  10. van der Gaag NA, Verhaar AC, Haverkort EB, et al. Chylous ascites after pancreaticoduodenectomy: introduction of a grading system. J Am Coll Surg. 2008;207:751–7. https://doi.org/10.1016/j.jamcollsurg.2008.07.007.

    Article  PubMed  Google Scholar 

  11. Pan W, Yang C, Cai SY, et al. Incidence and risk factors of chylous ascites after pancreatic resection. Int J Clin Exp Med. 2015;8:4494–500.

    PubMed  PubMed Central  Google Scholar 

  12. Aoki H, Takakura N, Shiozaki S, et al. Milk-based test as a preventive method for chylous ascites following pancreatic resection. Dig Surg. 2010;27:427–32. https://doi.org/10.1159/000320692.

    Article  PubMed  Google Scholar 

  13. Aoki H, Utsumi M, Sui K, et al. Changes over time in milk test results following pancreatectomy. World J Gastrointest Surg. 2016;8:246–51. https://doi.org/10.4240/wjgs.v8.i3.246.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Abu Hilal M, Layfield DM, Di Fabio F, et al. Postoperative chyle leak after major pancreatic resections in patients who receive enteral feed: risk factors and management options. World J Surg. 2013;37:2918–26. https://doi.org/10.1007/s00268-013-2171-x.

    Article  PubMed  Google Scholar 

  15. Creutzfeldt W, Lembcke B, Folsch UR, et al. Effect of somatostatin analogue (SMS 201–995, Sandostatin) on pancreatic secretion in humans. Am J Med. 1987;82:49–54. https://doi.org/10.1016/0002-9343(87)90426-8.

    Article  CAS  PubMed  Google Scholar 

  16. Gianotti L, Besselink MG, Sandini M, et al. Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2018;164:1035–48. https://doi.org/10.1016/j.surg.2018.05.040.

    Article  PubMed  Google Scholar 

  17. D’Hondt M, Foubert K, Penninckx F, et al. Lymphangiography as a treatment method for chylous ascites following pancreaticoduodenectomy. J Gastrointest Cancer. 2011;42:272–4. https://doi.org/10.1007/s12029-010-9240-2.

    Article  PubMed  Google Scholar 

  18. Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol. 1998;9:727–34. https://doi.org/10.1016/s1051-0443(98)70382-3.

    Article  CAS  PubMed  Google Scholar 

  19. Kim J, Won JH. Percutaneous treatment of chylous ascites. Tech Vasc Interv Radiol. 2016;19:291–8. https://doi.org/10.1053/j.tvir.2016.10.006.

    Article  PubMed  Google Scholar 

  20. Kollmar O, Schilling MK, Buchler MW. Treatment of chyloperitoneum after extended lymphatic dissection during duodenopancreatectomy. Int J Pancreatol. 2000;27:83–7. https://doi.org/10.1385/IJGC:27:1:83.

    Article  CAS  PubMed  Google Scholar 

  21. Corradini S, Liebig S, Niemoeller OM, et al. Successful radiation treatment of chylous ascites following pancreaticoduodenectomy. Strahlenther Onkol. 2015;191:448–52. https://doi.org/10.1007/s00066-014-0805-z.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Salvatore Paiella .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Paiella, S., Lionetto, G., Salvia, R. (2021). Chyle Leak After Pancreatic Surgery. In: Søreide, K., Stättner, S. (eds) Textbook of Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-53786-9_66

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-53786-9_66

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53785-2

  • Online ISBN: 978-3-030-53786-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics