Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Transplantation. 2019 Apr;103(4):e74-e78. doi: 10.1097/TP.0000000000002514.
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.
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.
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.
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.
乳糜性腹水（CA）是腹腔镜供肾切术后（LDN）极为罕见的并发症。它会增加住院时间和术后发病率，从而否定腹腔镜手术的益处。大多数病例采用保守治疗，但偶尔可能需要手术干预。本报告描述了在对保守治疗无反应的供体中准确定位渗漏乳糜管并通过内镜缝合修复的重要性。
使用 Pubmed/Medline 和 Google Scholar 对 LDN 后发生这种罕见并发症的文献进行全面综述，使用“乳糜”、“并发症”和“腹腔镜供肾切除术”作为关键字。详细讨论了患者的人口统计学特征和治疗方法。描述了用于治疗这些患者的各种手术方式。
迄今为止，文献中已有 54 例 LDN 后乳糜漏/腹水的报道。大约 77%的 CA 供体可以通过饮食措施和全胃肠外营养成功保守治疗。近 23%的供体需要手术干预，包括夹闭、氩气凝固、在保守治疗失败后 36.1±19.07 天应用胶水进行内镜缝合。大量腹水或需要频繁大量腹腔穿刺放液的供体可能需要手术治疗。本病例通过腹腔镜内镜缝合成功治疗，6 个月随访无复发。
乳糜性腹水是经验丰富中心供肾切术后罕见的并发症。尽管保守治疗仍是一线治疗，但在出现大量腹水时应尽早进行手术治疗。
