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Choi CI, Lee KJ, Kim MJ, Park JK, Kim DW, Kim HJ, Rhee H, Song SH, Seong EY, Kim DH, Jeon TY, Jung HJ. Learning curve analysis for hand-assisted laparoscopic living donor nephrectomy: an analysis of 96 consecutive cases performed by a trained gastrointestinal surgeon. Ann Surg Treat Res 2024; 107:81-90. [PMID: 39139834 PMCID: PMC11317363 DOI: 10.4174/astr.2024.107.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/09/2024] [Accepted: 06/22/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose This study aims to analyze the learning curve of hand-assisted laparoscopic living donor nephrectomy (HLDN) conducted by a trained gastrointestinal surgeon. Methods A retrospective analysis was performed on the perioperative clinical data of 96 consecutive patients who underwent HLDN from May 2013 to March 2023. The learning curve was evaluated using the cumulative sum (CUSUM) test based on operation time and risk-adjusted CUSUM for postoperative complications. Patients were divided into three groups (novice, development, and competency phases) based on changes in operation time. Patient demographics and perioperative outcomes were compared between each group. Results Among the patients, 35 were male, with a mean age of 48.9 ± 11.3 years and a mean body mass index (BMI) of 24.5 ± 3.2 kg/m2. The novice phase (phase 1) included the first 30 cases, with the development phase (phase 2) up to the 65th case. Operation times were significantly different across phases, averaging 263.2 ± 33.4, 211.1 ± 34.4, and 161.1 ± 31.3 minutes for phases 1, 2, and 3, respectively (P < 0.001). Blood loss decreased gradually across phases (phase 1, 264.7 ± 144.4 mL; phase 2, 239.7 ± 166.3 mL; phase 3, 198.8 ± 103.5 mL), though not statistically significant. BMI impacted operation time only in phase 1. Overall postoperative complications occurred in 13 cases (Clavien-Dindo grade I, 4 cases; grade II, 9 cases), with no significant differences across phases. Conclusion HLDN can be safely performed by a trained gastrointestinal surgeon, with approximately 30 cases needed to achieve proficiency.
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Affiliation(s)
- Chang In Choi
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kyeong Jun Lee
- Department of Mathematics and Big Data Science, Kumoh National Institute of Technology, Gumi, Korea
| | - Min Joo Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae-Kyun Park
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Da Woon Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyo Jin Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Harin Rhee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Heon Song
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Young Seong
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dae-Hwan Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Yong Jeon
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Zaman M, Ryncarz R, Chen A, Yildirim S, Iskhagi S, Saidi R, Bratslavsky G, Shahbazov R. Chylous Ascites After Robot-Assisted Laparoscopic Donor Nephrectomy: Is Early Surgical Intervention Necessary? EXP CLIN TRANSPLANT 2023; 21:397-407. [PMID: 37334687 DOI: 10.6002/ect.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Chylous ascites is a rare complication that may occur after living donor nephrectomy. The continuous loss of lymphatics, which carries a high risk of morbidity, may ensue in possible immunodeficiency and protein-calorie malnutrition. Here, we presented patients who developed chylous ascites after robotassisted living donor nephrectomy and reviewed the current literature of therapeutic strategies for chylous ascites. MATERIALS AND METHODS We reviewed the medical records of 424 laparoscopic living donor nephrectomies performed at a single transplant center; among these, we studied the records of 3 patients who developed chylous ascites following robot-assisted living donor nephrectomy. RESULTS Among 438 living donor nephrectomies, 359 (81.9%) were laparoscopic and 77 (18.1%) were by robotic assistance. In the 3 cases highlighted in our study, patient 1 did not respond to conservative therapy, which consisted of diet optimization, total parenteral nutrition, and octreotide (somatostatin). Patient 1 subsequently underwent robotic-assisted laparoscopy with suture ligation and clipping of leaking lymphatic vessels, allowing the chylous ascites to subside. Patient 2 similarly did not respond to conservative treatment and developed ascites. Despite initial improvement after wound interrogation and drainage, patient 2 had continued symptoms, resulting in diagnostic laparoscopy and repair of leaky channels leading to the cisterna chyli. Patient 3 developed chylous ascites 4 weeks postoperatively and received ultrasonographic-guided paracentesis by interventional radiology, with results showing an aspirate consistent with chyle. The patient's diet was optimized, allowing for initial improvement and eventual return to normal diet. CONCLUSIONS Our case series and literature review demonstrate the importance of early surgical intervention after failed conservative management for resolution of chylous ascites in patients after robotassisted donor laparoscopic nephrectomy.
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Affiliation(s)
- Muizz Zaman
- From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York; the Choate Rosemary Hall, Wallingford, Connecticut
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Buksh O, Almalki AM, Jar A, Alzahrani H, Bitar H, Al-Akraa M. Chylous Ascites Following Laparoscopic Donor Nephrectomy: A Case Report. Cureus 2023; 15:e38416. [PMID: 37273336 PMCID: PMC10233342 DOI: 10.7759/cureus.38416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Chylous ascites is a form of peritoneal fluid accumulation that can arise from trauma or lymphatic obstruction. In this report, we present the first case of chylous ascites following laparoscopic donor nephrectomy in our high-volume kidney transplant center. The patient presented to the emergency department three weeks post-procedure with complaints of abdominal distention and discomfort, accompanied by constipation and nausea. Radiological confirmation of ascites was followed by paracentesis, which yielded 20 mL of milky fluid that was analyzed and confirmed as chylous ascites. A subsequent pigtail drain was inserted, resulting in a total drainage of 4 L of fluid. Chylous ascites is a rare complication of abdominal surgeries, with higher body mass index and the American Society of Anesthesiologists physical status score system being significant risk factors. Conservative management involving diet modification is the initial therapy, with percutaneous drainage or more aggressive surgical interventions considered if conservative measures are not effective, with high success rates reported for these interventions. Here, we report a case of chylous ascites following donor nephrectomy as the first case reported from our region.
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Affiliation(s)
- Omar Buksh
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Abdullah M Almalki
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Anfal Jar
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hani Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Hussam Bitar
- Department of General Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Mahmoud Al-Akraa
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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4
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Hoa TQ, Cuong NN, My TTT, Linh LT, Hoan L, Canh PH, Tinh TQ, Chi TNK, Luu DT, Long H. Chylous ascites after donor nephrectomy: MR lymphangiography and lymphatic embolization treatment. Radiol Case Rep 2023; 18:1029-1032. [PMID: 36684632 PMCID: PMC9849999 DOI: 10.1016/j.radcr.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
Chylous ascites results from the leakage of lipid-rich lymphatic fluid into the peritoneal cavity. Most postsurgical chylous ascites occurs following abdominal aortic surgeries. However, rarely, it is a complication after laparoscopic donor nephrectomy. Postsurgical chylous ascites are often managed with conservative treatment or surgery, but lymphatic embolization may be required. Here, we presented a 45-year-old male patient who was referred for abdominal distension for 1 week after left donor nephrectomy. The drain fluid was milky and fluid analysis revealed high concentrations of triglycerides and chylomicron, confirming diagnosis of chylous ascites. The patient was treated with conservative therapy including a low-fat diet and fluid drainage but continued to have high draining output (up to 1500-2000 mL/24 h). He underwent magnetic resonance lymphangiography and intranodal lymphangiography, revealing extravasation of contrast into the abdomen and the left renal fossa. We embolized the interstitial lymphatic of the left retroperitoneal and lymphatic vessels leak. The patient was discharged from hospital at the fifth day after intervention. In this article, we demonstrate lymphatic lesions, the safety, and success of this technique.
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Affiliation(s)
- Tran Quoc Hoa
- Urology Surgery Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Ngoc Cuong
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam,Corresponding author.
| | - Thieu Thi Tra My
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Tuan Linh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Le Hoan
- Respiratory Department, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Hong Canh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Trieu Quoc Tinh
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tran Nguyen Khanh Chi
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Doan Tien Luu
- Diagnostic Imaging and Interventional Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Hoang Long
- Urology Surgery Department, Hanoi Medical University Hospital, Hanoi, Vietnam
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Kalia S, Narkhede A, Yadav AK, Bhalla AK, Gupta A. Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites. CEN Case Rep 2022; 11:1-5. [PMID: 34218419 PMCID: PMC8811106 DOI: 10.1007/s13730-021-00618-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Chylous ascites is a rare, potentially sinister complication in post donor nephrectomy patients which may cause significant morbidity in form of severe malnutrition and an immuno-compromised state. We present two patients with post donor nephrectomy-related chylous leaks who failed conservative treatment. In both cases, lymphangiography was done first to detect the chylous leak site in the left renal fossa, and thereafter transvenous retrograde approach via left subclavian vein with selective lymphatic duct embolization of chylous leak was done with coils and glue successfully. Chylous ascites resolved in both patients after the embolization. Hence retrograde transvenous embolization technique appears to be an effective management option for refractory chylous leaks.
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Affiliation(s)
- Shekhar Kalia
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Kumar Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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Hiffa A, Schulte K, Saeed M, Gani I. Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization. J Investig Med High Impact Case Rep 2022; 10:23247096211065631. [PMID: 35038891 PMCID: PMC8771747 DOI: 10.1177/23247096211065631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chylous ascites may result from a variety of pathological conditions, most of them from nontraumatic causes, such as congenital defects of the lymphatic system, infections, liver cirrhosis, and malignancy. Rarely, chylous ascites occurs as an iatrogenic complication after left-sided laparoscopic donor nephrectomy (LDN). Injury to the cisterna chyli and its main lymphatic tributaries around the para-aortic region intraoperatively can cause the lymphatic fluid to accumulate. There is currently no standardized treatment for chylous ascites as there have only been 54 cases documented to date. Most patients can be managed with conservative therapy. Recommended guidelines include high-protein and low-fat diet with medium-chain triglycerides. Paracentesis is often used as a diagnostic and therapeutic first-line measure with total parenteral nutrition (TPN), bowel rest, and somatostatin analogue as adjunct therapies. We present a case of massive chylous ascites refractory to conservative therapy. The patient had progressive abdominal distention and unintentional weight gain 2 weeks postoperatively warranting multiple paracenteses of >7 L of chylous fluid. Ultimately, the patient was successfully treated with lymphatic embolization using N-butyl cyanoacrylate glue.
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7
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Bhandari G, Tiwari V, Gupta A, Bhargava V, Malik M, Gupta A, Bhalla AK, Rana DS. Chylous Ascites after Laparoscopic Donor Nephrectomy: Case Report. Indian J Nephrol 2021; 31:482-484. [PMID: 34880560 PMCID: PMC8597792 DOI: 10.4103/ijn.ijn_391_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
Chylous ascites refers to the accumulation of chyle in the abdominal cavity. Postoperative chylous ascites is most commonly associated with abdominal aortic surgeries. However, it is a rare complication following laparoscopic nephrectomy. It causes loss of fat, protein, and antibodies causing malnutrition and immunodeficiency. Thus, it is important to treat it as early as possible. We hereby report a case of chylous ascites following laparoscopic donor nephrectomy. A 55-year-old female was admitted at our center 2 weeks after undergoing left laparoscopic donor nephrectomy with abdominal distension and constipation. USG abdomen revealed free fluid in the abdomen. Paracentesis revealed chylous ascites. The patient was started on conservative treatment, including a diet rich in proteins and low in fats; conservative treatment, however, was unsuccessful. Lymphangiography and subsequent embolization of the defect were done, and she made a full recovery.
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Affiliation(s)
- Gaurav Bhandari
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vaibhav Tiwari
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Malik
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashwani Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | | | - D S Rana
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
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8
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Alwatari Y, Raza O, Ruch B, Bhati C, Levy M, Sharma A. Chyle Leak After Robotic Living Donor Nephrectomy: Literature Review And Management. EXP CLIN TRANSPLANT 2021; 20:945-949. [PMID: 34546160 DOI: 10.6002/ect.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chyle leak after living donor nephrectomy is a rare complication and is associated with a significant postoperative burden. To the best of our knowledge, only 1 case of chyle leak after robotic living donor nephrectomy has been reported in the literature. In this study, we present our experience with 2 cases of chyle leak: 1 after and 1 during robotic donor nephrectomy. We discuss previously published studies and man - agement options of chyle leak in kidney donors.
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Affiliation(s)
- Yahya Alwatari
- From the Virginia Commonwealth University, Department Of Transplant Surgery, Richmond, Virginia, USA
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9
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Chu CF, Wu CT, Hsieh WC, Huang JJ. Management of intractable post-adrenalectomy chylous ascites with microsurgical intra-abdominal lymphaticovenous anastomosis: A case report and literature review. Microsurgery 2021; 41:480-487. [PMID: 33822407 DOI: 10.1002/micr.30740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
Postoperative chylous ascites is a rare but highly morbid complication following thoracic or abdominal surgeries. Treatment options vary according to different clinical scenarios and facility equipment, but there is no standard guideline. We report a case of 46-year-old patient with chylous ascites after left laparoscopic adrenalectomy for metastatic lung cancer. The conservative treatments failed, included diet control, somatostatin provided and intranodal lymphangiography with lipiodol injection. Laparotomy was performed to explore the lymphatic vessel in the retroperitoneal area where a major and several small leaking holes were identified along the thoracic duct. The left gonadal vein was explored and transposed toward the lymphatic vessel. The lymphaticovenous anastomosis (LVA) was done using side (major leaking hole) to end (gonadal vein) fashion. The chylous leakage dropped from 2000 to 200 mL per day gradually within 10 days after LVA, and the patient was discharged uneventfully 30 days after the LVA surgery. He was followed at our clinic during the first postoperative 10 months without recurrent chylous ascites. This case demonstrates that microsurgical intervention with LVA to physiologically drain the chyle can be an optimal treatment for chylous ascites. A literature review was also conducted, and strategic management is proposed.
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Affiliation(s)
- Cheng-Feng Chu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Te Wu
- Department of Urology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chuan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jung-Ju Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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Veracierto F, Sanchez N, Mosna L, Vegas DH, Salgado R. Management of Chylous Ascites After Laparoscopic Nephrectomy for Living Kidney Donor: A Case Report and Literature Review. Transplant Proc 2020; 53:1251-1256. [PMID: 33288311 DOI: 10.1016/j.transproceed.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/30/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
Kidney transplant is currently the elective treatment of choice for end-stage renal disease. Laparoscopic living donor nephrectomy (LLDN) has substantial advantages over open nephrectomy. Chylous ascites (CA) is a rare surgical complication after the LLDN; there are few reports in the literature. We present a case report of a 58-year-old woman who started CA on the 21st day post operation. The recommended initial therapeutic approach to suspend the fat in the diet and place percutaneous drainage was not enough. It was decided to jointly introduce fasting and total parenteral nutrition with the administration of octreotide, resolving the complication completely in 15 days with no need for the patient to undergo surgery. The conservative management, during the first 4 to 8 weeks after the diagnosis is the best option. Surgery is generally recommended if conservative management fails. The prevalence of CA varied between 0% and 6.2% of LLDNs. In our experience of 87 LLDNs, we only presented 1.15% for this complication. There are 62 cases reported in the international literature. The mean presentation was 14 days after LLDN. All patients underwent conservative treatment, and only 15 patients (24%) went to surgery after the failure of conservative management. It would be highly useful, considering the disparity of the prevalence, if the bibliographic reports detail what hemostatic and sealing techniques are used in an LLDN. In this way it would be possible to identify which factor affects a complication like this one.
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Affiliation(s)
- Federico Veracierto
- General Surgery Service, CEMIC University Hospital, Buenos Aires, Argentina.
| | - Nicolas Sanchez
- Kidney and Kidney-Pancreatic Transplant Unit, CEMIC University Hospital, Buenos Aires, Argentina
| | - Leandro Mosna
- Kidney and Kidney-Pancreatic Transplant Unit, CEMIC University Hospital, Buenos Aires, Argentina
| | - Diego Herrera Vegas
- Kidney and Kidney-Pancreatic Transplant Unit, CEMIC University Hospital, Buenos Aires, Argentina; Peripheral Vascular Surgery Service, CEMIC University Hospital, Buenos Aires, Argentina
| | - Roberto Salgado
- General Surgery Service, CEMIC University Hospital, Buenos Aires, Argentina; Kidney and Kidney-Pancreatic Transplant Unit, CEMIC University Hospital, Buenos Aires, Argentina
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Kostov S, Yordanov A, Slavchev S, Strashilov S, Dzhenkov D. First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E624. [PMID: 31547593 PMCID: PMC6843166 DOI: 10.3390/medicina55100624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
Introduction: Chylous ascites is a rare form of ascites characterized by milk-like peritoneal fluid, rich in triglycerides. Clinical signs and symptoms include abdominal distention, pain, nausea, and vomiting. In gynecology, the most common cause for its occurrence is lymph dissection leading to impairment of major lymphatic vessels. There are only a few reported cases of chylous ascites arising after operations for benign diseases. Case report: We report a case of a 46-year-old female patient, who underwent laparoscopy for a myomatous node with chylous ascites occurring on post-surgery Day 2. The ascites was conservatively managed. The exact cause of the chyloperitonitis could not be determined. Conclusion: Although extremely rarely, chylous ascites may also occur in operative interventions for benign diseases in gynecological surgery.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria.
| | - Strahil Strashilov
- Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University Pleven, 5800 Pleven, Bulgaria.
| | - Deyan Dzhenkov
- Department of General and Clinical pathology, Forensic Medicine and Deontology, Medical University Varna, 9002 Varna, Bulgaria.
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12
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Chylous Ascites: Complication of Laparoscopic Donor Nephrectomy. Case Report and Review of Literature. Transplantation 2019; 103:e74-e78. [PMID: 30399121 DOI: 10.1097/tp.0000000000002514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Dale L, Sandoval PR, Ratner LE. Chylous ascites following laparoscopic live donor nephrectomy: A new improved treatment paradigm. Clin Transplant 2019; 33:e13483. [DOI: 10.1111/ctr.13483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Leigh‐Anne Dale
- Columbia Vagelos College of Physicians and Surgeons New York New York
| | | | - Lloyd E. Ratner
- Department of Surgery Columbia University Medical Center New York New York
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14
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Choi CI, Kim DI, Baek SH, Chung YS, Kim DH, Jeon TY, Kim DH, Rhee H, Song SH, Seong EY, Kwak IS. Initial Experience With Hand-Assisted Laparoscopic Living Donor Nephrectomy: Training and Clinical Practice as a General Surgeon. Transplant Proc 2018; 50:3113-3120. [PMID: 30577176 DOI: 10.1016/j.transproceed.2018.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 08/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND To analyze our initial results of hand-assisted laparoscopic living donor nephrectomy, executed by a skilled gastrointestinal surgeon. METHODS A total of 22 consecutive patients underwent the hand-assisted laparoscopic living donor nephrectomy between December 2014 and January 2017. We retrospectively analyze the patient's perioperative clinical data, which were collected prospectively. RESULTS The right kidney was harvested in 12 patients. The mean operative time and intraoperative blood loss was 241.0 ± 43.4 minutes (range, 140-310 min) and 293.2 ± 203.1 mL (range, 50-700 mL), respectively. The mean warm ischemic time was 288.4 ± 103.4 seconds (range, 179-610 s). Postoperative complications included chyle leakage in 2 patients who were left kidney donors and oliguria in 1 patient who was a right kidney donor. All patients recovered with conservative care, and the mean hospital stay was 7.5 ± 1.7 days. The mean creatinine level was 0.7 ± 0.2 mg/dL before surgery, 1.1 ± 0.3 mg/dL at postoperative day (POD) 1, and 1.0 ± 0.2 mg/dL after discharge. The mean glomerular filtration rate was 97.9 ± 18.2 mL/min/1.73 m2 before surgery, 60.7 ± 10.4 at POD 1, and 67.3 ± 11.1 after discharge. Operation time was not associated with patient body mass index and case number. No significant differences, other than postoperative complications, were found in the perioperative data for the side of kidney donation. CONCLUSION A skilled surgeon with experience in laparoscopic abdominal surgery (such as gastrectomy or colectomy) might safely perform hand-assisted donor nephrectomy. However, we could not identify a clear case number to complete the learning curve.
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Affiliation(s)
- C I Choi
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D I Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Baek
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - Y S Chung
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea.
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - H Rhee
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Song
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - E Y Seong
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - I S Kwak
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
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Tae BS, Balpukov U, Kim HH, Jeong CW. Evaluation of the Learning Curve of Hand-Assisted Laparoscopic Donor Nephrectomy. Ann Transplant 2018; 23:546-553. [PMID: 30082679 PMCID: PMC6248071 DOI: 10.12659/aot.909397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, we analyzed the learning curve of hand-assisted laparoscopic donor nephrectomy (HALDN). MATERIAL AND METHODS The first 198 consecutive donors (110 cases by expert surgeon and 88 cases by newbie surgeon) operated on using HALDN were included in this study. The primary outcome measures were warm ischemic time (WIT), total operation time and estimated blood loss (EBL). The secondary outcome measures included length of hospital stay (LOS), graft outcome, and surgery-related complications. We used the cumulative sum (CUSUM) method to generate learning curves. RESULTS Except for WIT, all operative and convalescence parameters of donors and graft outcomes were similar for the 2 groups, including the total operation time (174.13 minutes vs. 171.75 minutes, P=0.140), EBL (108.27 cc vs. 116.82 cc, P=0.494), LOS (4.80 days vs. 4.92 days, P=0.144), and overall rates of intraoperative and postoperative complications (P>0.05). A significant difference was observed in WIT between the 2 groups (140.59 sec vs. 106.85 sec, P=0.027). Upon visual assessment of the CUSUM plots, a downward inflexion point for decreasing WIT was observed in 4 cases, total operation time in 12 cases, and EBL in 15 cases. CONCLUSIONS HALDN has a relatively short learning curve and similar results may be expected from newbie urologists who are trained in minimally invasive surgery fellowship.
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Ulanbek Balpukov
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
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Ng ZQ, He B. A Proposed Classification System and Therapeutic Strategy for Chyle Leak After Laparoscopic Living-Donor Nephrectomy: A Single-Center Experience and Review of the Literature. EXP CLIN TRANSPLANT 2017; 16:143-149. [PMID: 29108520 DOI: 10.6002/ect.2016.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Chyle leak or chylous ascites remains a rare complication after laparoscopic living-donor nephrectomy. Its cause and management have not been well elucidated in the literature. Thus, the aim of this study was to review the incidence of chyle leak/chylous ascites after laparoscopic living-donor nephrectomy in our institute and in the literature to propose a classification system with its associated treatment strategy. MATERILAS AND METHODS In this retrospective review of laparoscopic living-donor nephrectomy patients from January 2005 to April 2016, we identified patients with chyle leak/chylous ascites along with the care performed. A proposed classification system based on our experience and literature is described. RESULTS Chylous leak developed in 4 donors (2.25%). Of the 4 donors, 3 were treated nonoperatively with diet modification and subcutaneous octreotide injection. One patient required surgical intervention after not responding to second-line therapy with total parenteral nutrition. CONCLUSIONS Chyle leak/chylous ascites after laparoscopic living-donor nephrectomy is rare, but a delayed diagnosis may lead to morbidity secondary to malnutrition and immunosuppression. Meticulous surgical dissection is essential to seal the lymphatic tubes during laparoscopic living-donor nephrectomy. The proposed classification system provides a practical and tailored guide to management based on the drainage volume of chyle leak and a guide to the earlier identification of refractory cases.
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Affiliation(s)
- Zi Qin Ng
- From the WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Ilhan E, Demir U, Alemdar A, Ureyen O, Eryavuz Y, Mihmanli M. Management of high-output chylous ascites after D2-lymphadenectomy in patients with gastric cancer: a multi-center study. J Gastrointest Oncol 2016; 7:420-5. [PMID: 27284475 DOI: 10.21037/jgo.2016.02.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aimed to propose treatment strategies for high-output chylous ascites (CA) developed after gastric cancer surgery. METHODS The data of patients with CA after gastric cancer surgery in three high volume Training and Research Hospitals between 2005 and 2015 were retrospectively evaluated. RESULTS Nine patients out of 436 gastrectomies were detected with CA. The mean amount of daily fistula output was 939 mL. Treatment consisted of cessation of oral feeding, total parenteral nutrition (TPN), somatostatin analogs administration, clamping and/or removal of the drainage tube, diuretic administration and diet therapy with medium-chain triglycerides (MCTs) alone or in combination. The mean fistula closure time and length of hospital stay were 23 and 24 days respectively. Hemopneumothorax developed during right subclavian vein catheterisation for TPN implementation in one patient. There was no mortality. CONCLUSIONS Combined cessation of oral feeding and TPN are usually used for treatment of CA as first-line treatment. However, TPN is no harmless. Although our data are limited they do allow us to conclude that diet with MCT's may use for medical treatment of CA as first-line.
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Affiliation(s)
- Enver Ilhan
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Uygar Demir
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ali Alemdar
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Orhan Ureyen
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Eryavuz
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mihmanli
- 1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Kim BS, Kwon TG. Chylous ascites in laparoscopic renal surgery: Where do we stand? World J Clin Urol 2016; 5:37-44. [DOI: 10.5410/wjcu.v5.i1.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Postoperative chylous ascites, which is caused by the disruption of lymphatic channels and persistent lymphatic leakage, was a rare complication in the urologic field before laparoscopic surgery was introduced. Now that laparoscopic urologic surgery, especially laparoscopic nephrectomy, is widely performed, chylous ascites as a complication of laparoscopic renal surgery has been reported more frequently. With these accumulated experiences and data comes knowledge about the proper diagnosis and management of chylous ascites, although there is still some debate regarding the correct protocol for diagnosis and management. Therefore, we performed a systematic review of the current literature regarding the etiology, incidence, diagnosis, management, and prognosis of chylous ascites after laparoscopic renal surgery, as well as strategies used to prevent it, and discuss current perspectives on overcoming this complication in the laparoscopic age.
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Arnold CE, Taylor T, Chaffin MK, Schott HC, Caron JP. Nephrectomy Via Ventral Median Celiotomy in Equids. Vet Surg 2015; 42:275-9. [DOI: 10.1111/j.1532-950x.2013.01095.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn E. Arnold
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - Tex Taylor
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - M. Keith Chaffin
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Texas A&M University; College Station, TX
| | - Harold C. Schott
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine, Michigan State University; East Lansing, MI
| | - John P. Caron
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine, Michigan State University; East Lansing, MI
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Guglielmo N, Melandro F, Nudo F, Mennini G, Levi Sandri GB, Berloco PB, Rossi M. Chylous Leakage After a Laparoscopic Live-Donor Nephrectomy: Case Report and Literature Review. EXP CLIN TRANSPLANT 2015; 14:338-40. [PMID: 26340725 DOI: 10.6002/ect.2014.0123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Laparoscopic donor nephrectomy is an established operation for organ procurement in living-donor transplant. Minimal access approach for organ procurement from living donors ensures early convalescence and improved patient participation. Chylous leakage is a rare complication of laparoscopic living-donor nephrectomy. Chylous leakage is mostly determined by iatrogenic injury of cisterna chyli and its main tributaries. It may lead to malnutrition and immunologic deficits because of protein and lymphocyte depletion. An 18-year-old woman underwent left-hand-assisted laparoscopic donor nephrectomy for living donor transplant. She developed chylosus leakage in third postoperative day. A conservative manage-ment with total parenteral nutrition total paren-teral nutrition and subcutaneous somatostatin was immediately initiated. The patient had an abatement of drainage daily output in 4 days of therapy. Chylous leakage is a potentially insidious and perhaps misdiagnosed complication of laparoscopic donor nephrectomy. Conservative therapy is effective in most donors and should be initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory chylous leakage before the arising of malnutrition and/or relevant immunodeficiency.
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Affiliation(s)
- Nicola Guglielmo
- From the Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Universita di Roma, Policlinico Umberto I, Rome, Italy
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Jairath A, Singh A, Ganpule A, Mishra S, Sabnis R, Desai M. Management Protocol for Chylous Ascites After Laparoscopic Nephrectomy. Urology 2015. [PMID: 26210005 DOI: 10.1016/j.urology.2015.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To devise a management protocol for chylous ascites after laparoscopic nephrectomy. PATIENTS AND METHODS We retrospectively reviewed the data of the patients that underwent laparoscopic nephrectomy between January 2010 and January 2014 in our institution for different indications and were diagnosed with chylous ascites. We also analyzed a different management protocol that was used. RESULTS The overall incident rate of chylous ascites was 0.77%. It was more commonly seen on left side and with simple nephrectomy rather than radical. Three out of 9 patients were managed by surgical intervention, rest were successfully managed on conservative treatment in the form of dietary modification, total parenteral nutrition, or octreotide. CONCLUSION Chylous ascites is a rare but morbid condition following laparoscopic nephrectomy. To manage this complication, we propose preventive and treatment strategies based on symptoms and amount of chylous ascites using our experience and review of the literature.
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Affiliation(s)
- Ankush Jairath
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India.
| | - Abhishek Singh
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Shashikant Mishra
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra Sabnis
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh Desai
- Department of Urology, Muljhibhai Patel Urological Hospital, Nadiad, Gujarat, India
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22
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Steven BR, Carey S. Nutritional management in patients with chyle leakage: a systematic review. Eur J Clin Nutr 2015; 69:776-80. [DOI: 10.1038/ejcn.2015.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 08/24/2014] [Accepted: 01/23/2015] [Indexed: 01/10/2023]
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Tiong HY, Goel RK, White WM, Goldfarb DA, Kaouk JH. Chylous ascites after laparoscopic donor nephrectomy. Asian J Endosc Surg 2015; 8:34-9. [PMID: 25384614 DOI: 10.1111/ases.12144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine the incidence, presentation, management, and outcomes of chylous ascites following laparoscopic donor nephrectomy. METHODS An Internet-based, multi-institutional survey was performed using http://www.surveymonkey.com. An email invitation to the voluntary survey was sent to 30 transplant centers and posted on CenterSpan, an email forum for transplant surgeons. The number of living donor transplantations and the number of cases of chylous ascites with clinical information, treatment and outcomes were sought from the questionnaire. RESULTS A total of 12 centers responded and reported 7683 cases of live donor nephrectomy. The reported incidence of postoperative chylous ascites was 0.013% (n = 12). Six centers reported 10 cases of chylous ascites following laparoscopic donor nephrectomy and 2 cases after open donor nephrectomy. Among the eight patients who developed chylous ascites following laparoscopic donor nephrectomy, presentation was typically 2 weeks after the date of initial surgery. Conservative therapy was successful in 50% of cases. Refractory ascites managed secondarily with surgical intervention had a success rate of 100%. CONCLUSION Chylous ascites is a rare complication following laparoscopic donor nephrectomy. Initial treatment should be conservative, with surgical therapy reserved for refractory cases.
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Affiliation(s)
- Ho Yee Tiong
- The Transplant Center, Glickman Kidney and Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Esene IN, Ngu J, El Zoghby M, Solaroglu I, Sikod AM, Kotb A, Dechambenoit G, El Husseiny H. Case series and descriptive cohort studies in neurosurgery: the confusion and solution. Childs Nerv Syst 2014; 30:1321-32. [PMID: 24938735 DOI: 10.1007/s00381-014-2460-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Case series (CS) are well-known designs in contemporary use in neurosurgery but are sometimes used in contexts that are incompatible with their true meaning as defined by epidemiologists. This inconsistent, inappropriate and incorrect use, and mislabeling impairs the appropriate indexing and sorting of evidence. METHOD Using PubMed, we systematically identified published articles that had "case series" in the "title" in 15 top-ranked neurosurgical journals from January 2008 to December 2012. The abstracts and/or full articles were scanned to identify those with descriptions of the principal method as being "case series" and then classified as "true case series" or "non-case series" by two independent investigators with 100 % inter-rater agreement. RESULTS Sixty-four articles had the label "case series" in their "titles." Based on the definition of "case series" and our appraisal of the articles using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, 18 articles (28.13 %) were true case series, while 46 (71.87 %) were mislabeled. Thirty-five articles (54.69 %) mistook retrospective (descriptive) cohorts for CS. CS are descriptive with an outcome-based sampling, while "descriptive cohorts" have an exposure-based sampling of patients, followed over time to assess outcome(s). A comparison group is not a defining feature of a cohort study and distinguishes descriptive from analytic cohorts. CONCLUSION A distinction between a case report, case series, and descriptive cohorts is absolutely necessary to enable the appropriate indexing, sorting, and application of evidence. Researchers need better training in methods and terminology, and editors and reviewers should scrutinize more carefully manuscripts claiming to be "case series" studies.
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Esene IN, Kotb A, ElHusseiny H. Five is the maximum sample size for case reports: statistical justification, epidemiologic rationale, and clinical importance. World Neurosurg 2014; 82:e659-65. [PMID: 24831106 DOI: 10.1016/j.wneu.2014.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Ignatius Ngene Esene
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt; Research Associate, Gamma Knife Center, Nasser Institute, Cairo, Egypt; Encyclopaedia Neurochirurgica, Paris, France.
| | - Ali Kotb
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
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Sharma S, Rizvi SJ, Modi PR. Medical management of chyloretroperitoneum following retroperitoneoscopic donor nephrectomy. Indian J Nephrol 2014; 24:129-30. [PMID: 24701051 PMCID: PMC3968605 DOI: 10.4103/0971-4065.127916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Sharma
- Department of Urology, IKDRC-ITS, Asarwa, Ahmedabad, Gujarat, India
| | - S J Rizvi
- Department of Urology, IKDRC-ITS, Asarwa, Ahmedabad, Gujarat, India
| | - P R Modi
- Department of Urology, IKDRC-ITS, Asarwa, Ahmedabad, Gujarat, India
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Chylous Ascites: Evaluation and Management. ISRN HEPATOLOGY 2014; 2014:240473. [PMID: 27335837 PMCID: PMC4890871 DOI: 10.1155/2014/240473] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
Abstract
Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt.
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Meulen ST, van Donselaar-van der Pant KA, Bemelman FJ, Idu MM. Chylous ascites after laparoscopic hand-assisted donor nephrectomy: Is it specific for the left-side? Urol Ann 2013; 5:45-6. [PMID: 23662011 PMCID: PMC3643324 DOI: 10.4103/0974-7796.106967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/17/2011] [Indexed: 12/24/2022] Open
Abstract
We describe a case-report of a chylous ascites after laparoscopic donor nephrectomy, summarize the current literature, and hypothesize on the etiology of this complication.
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Affiliation(s)
- S Ter Meulen
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Chyle Leak following Open Donor Nephrectomy: A Rare Complication-A Case Report. Case Rep Transplant 2013; 2012:259838. [PMID: 23320242 PMCID: PMC3539371 DOI: 10.1155/2012/259838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/19/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction. Donor workup in renal transplantation is extensive. Despite this, chyle leakage following donor nephrectomy, a rare complication, has been reported in the literature. We encountered two cases of chyle leak in kidney donors in our series of open donor nephrectomies. Summary of Cases. After complete workup, standard open retroperitoneal donor nephrectomy with drain placement was performed in 684 living renal donors. We encountered chyle leak in two cases. The first case was a 33-year-old female who underwent an otherwise uneventful left donor nephrectomy but continued to have high drain output (upto 300–400 mL/24 hrs) in the postoperative period. The drain fluid was milky, raising the suspicion of chyle which was confirmed on biochemical analysis. The second case was a 42-year-old female with a similar case history. Both were managed conservatively with low-fat diet. The leak subsided spontaneously in three weeks and one week in the first and second patients, respectively. The drain was removed, and the patients remained symptom-free on followup. Conclusions. Both of our cases of chyle leak following open donor nephrectomy were managed successfully with conservative management. The management options and the experience of other centers are reviewed and discussed.
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Abstract
OBJECTIVES To analyze the concept of "case series" in the medical literature compared with case reports. METHODS A PubMed search for articles published during 2009 which had "case series" in their title was performed. A total number of 621 articles were retrieved. 586 papers were included in the analysis and 35 were excluded (18 were commentary letters, 5 were not in English, and twelve could not be retrieved by our Library). The number of patients and category of these articles were analyzed. RESULTS The median (range) of the number of cases of articles having "case series" in their title was 7 (1-6432) cases. 186/ 586 articles had less than 5 cases (31.7%, 95% CI (28.3-35.1%)). The median (range) of the number of cases of articles having "case report" as their publication type was 4 (1-178) cases. Out of the 219 articles categorized as case reports 114 (52.1%, 95% CI (45.6-58.6%)) had less than five cases. CONCLUSIONS The concept of "case series" is not well defined in the literature and does not reflect a specific research design. We suggest that a case series should have more than four patients while four paitents or less should be reported individually as case reports.
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Affiliation(s)
- F M Abu-Zidan
- Trauma Research Group, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE.
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Morbidity of 200 consecutive cases of hand-assisted laparoscopic living donor nephrectomies: a single-center experience. J Transplant 2012; 2012:121523. [PMID: 22530106 PMCID: PMC3316965 DOI: 10.1155/2012/121523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/13/2011] [Indexed: 01/10/2023] Open
Abstract
Background. Recipients of laparoscopically procured kidneys have been reported to have delayed graft function, a slower creatinine nadir, and potential significant complications. As the technique has evolved laparoscopic donor nephrectomy technique is becoming the gold standard for living donation. Study Design. We retrospectively reviewed the data of the first 200 hand-assisted laparoscopic living donor nephrectomies performed between January 2003 and February 2009. The initial 41 donors and their recipients (Group 1) were compared to the next 159 donors and their recipients (Group 2). The estimated blood loss, serum creatinine at discharge and 6 months, and the incidence of delayed graft function and perioperative complications were analyzed. Results. The median donor serum creatinine at discharge and 6 months was 1.2 mg/dL in each group. None of the laparoscopic procedures required conversion to an open procedure, and none of the donors required perioperative blood transfusion. The median recipient serum creatinine at 6 months after transplant was 1.2 mg/dL for each group. No ischemic ureteral complications related to the laparoscopic technique were seen. Conclusions. HALDN with meticulous surgical technique allows kidney procurement with very low morbidity and no mortality. This improved safety and decreased invasiveness from laparoscopic approach may further decrease morbidity of the procedure and increase organ donation.
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Incidence, Diagnosis, and Treatment of Chylous Leakage After Laparoscopic Live Donor Nephrectomy. Transplantation 2012; 93:82-6. [DOI: 10.1097/tp.0b013e31823b2d8e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Steinemann DC, Dindo D, Clavien PA, Nocito A. Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg 2011; 212:899-905.e1-4. [PMID: 21398159 DOI: 10.1016/j.jamcollsurg.2011.01.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel C Steinemann
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
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