Laparoscopic approach for correction of chylous fistula after pelvic and paraaortic lymphadenectomy

Abstract

Chylous fistula is an uncommon but challenging complication after lymphadenectomy for treatment of gynecologic cancers. Its presence contributes substantially to increased morbidity and may retard the onset of adjuvant therapies. Treatment options include dietary modifications or surgical intervention. A 68-year-old woman with renal insufficiency developed chylous ascites after pelvic und para-aortic laparoscopic lymph node dissection followed by chemoradiation for treatment of class IIb cervical cancer. Conservative treatment failed, and the patient underwent laparoscopic exploration. The leakage was identified near the cisterna chyle, and was closed with sutures. There was no evidence of recurrence after 2-month follow-up. This case demonstrates successful laparoscopic management of chylous ascites after para-aortic lymphadenectomy and chemoradiation, using suturing.