[Post-surgical lymphocutaneous fistula, chylous ascites and chylothorax--infrequent but serious complications: etiology, diagnosis and therapeutic options]

Abstract

Lymphorrhea is an uncommon but potentially life-threatening complication following surgical procedures which strongly influences the outcome of surgical patients. Persistent lymphocutaneous fistula is mainly associated with an increased risk of local infections and wound complications. Chylous ascites and chylothorax can result in malnutrition, metabolic deterioration and immunosuppression that increase postsurgical morbidity. Diagnosis can easily be made by the characteristic milky-beige appearance of chylous fluid. Laboratory investigation of the drainage fluid (chylomicrons, triglycerides) enables to confirm diagnosis. Initial therapy favors conservative measures including drainage, pressure dressings, total parenteral nutrition and diet modifications. But this takes sometimes several weeks to control the chylous leak and leads to prolonged hospitalisation. Surgical options are only recommended if conservative therapy fails. However, surgical re-interventions are associated with significant incidence of morbidity and mortality. In addition, surgery may occasionally fail to identify the leak. Some promising new techniques have recently been introduced (application of octreotide or etilefrine, low-dose radiotherapy, use of sclerosing agents, subatmospheric pressure dressings or percutaneous embolization of cisterna chyli), which - alone or in combination with well-established conservative measures - may have the potential to avoid surgical re-interventions. Prevention of lymphorrhea during primary operation is of major importance. The present study focuses on current diagnostic and therapeutic options in the treatment of lymphocutaneous fistula, chylous ascites and chylothorax as the most frequent entities of lymphorrhea.