Chylous ascites in colorectal surgery: A systematic review

Abstract

Background: Chylous ascites is a rare complication in colorectal surgery with limited evidence.

Aim: To systematically review all available evidence to describe the incidence, clinical presentation, risk factors and management strategies.

Methods: The systematic review was performed through PubMed, MEDLINE, EMBASE and Cochrane and cross-checked up to November 2020. The data collated included: Demographics, indications (benign vs malignant), site of disease, surgical approach, extent of lymphadenectomy, day to and method of diagnosis of chylous ascites and management strategies.

Results: A total of 28 studies were included in the final analysis (426 cases). Patient age ranged from 31 to 89 years. All except one case were performed for malignancy. Of the 426 cases, 195 were right-colonic, 121 left-colonic, 103 pelvic surgeries and 7 others. The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume. Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis. Most cases were managed successfully non-operatively (fasting with prolonged drainage, total parenteral nutrition, somatostatin analogues or a combination of these). Only three cases required surgical intervention after failing conservative management and subsequently resolved completely. Risk factors identified include: Right-colonic surgery/ tumour location, extent of lymphadenectomy and number of lymph nodes harvested.

Conclusion: Chylous ascites after colorectal surgery is a relatively rare complication. Whilst the majority of cases resolved without surgical intervention, preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.

Keywords: Ascites; Chyle; Chylous; Colon; Leak; Lymphadenectomy; Rectum.

Figure 1

PRISMA flowchart of the search pathway for chylous ascites after colorectal surgery. RCT: Randomized controlled trial.

Figure 2

Schematic drawing demonstrating the close proximity of lymphatic vessels during lymphadenectomy in colorectal surgery.