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Abokhozima A, Zidan MH, Abo Elmagd A, Alokl M, Altabbaa H, Al Sayed M, Selim A. Lymphatic Chyle Duct Injury and Identification During Laparoscopic Sleeve Gastrectomy Preventing Postoperative Chylous Ascites. Obes Surg 2024; 34:1995-2000. [PMID: 38589758 PMCID: PMC11031454 DOI: 10.1007/s11695-024-07215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
We present a case of intraoperative detection of an iatrogenic chyle duct injury during laparoscopic sleeve gastrectomy. The chyle duct injury was identified and managed by ligature, preventing postoperative chylous ascites.
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Affiliation(s)
- Ahmed Abokhozima
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
- Ekbal Hospital, 10 Hassan Amin Street, Alexandria, Egypt
| | - Mohamed H Zidan
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt.
- Alexandria Main University Hospital, Al Mothaf, Al Mesallah Sharq, Al Attarin, Alexandria, 5372066, Egypt.
- Ekbal Hospital, 10 Hassan Amin Street, Alexandria, Egypt.
| | - Ahmed Abo Elmagd
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
- Alexandria Main University Hospital, Al Mothaf, Al Mesallah Sharq, Al Attarin, Alexandria, 5372066, Egypt
- Ekbal Hospital, 10 Hassan Amin Street, Alexandria, Egypt
| | - Mohammed Alokl
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
- Ekbal Hospital, 10 Hassan Amin Street, Alexandria, Egypt
| | - Hashem Altabbaa
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
| | - Mohamed Al Sayed
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
- Alexandria Main University Hospital, Al Mothaf, Al Mesallah Sharq, Al Attarin, Alexandria, 5372066, Egypt
| | - Aliaa Selim
- Alexandria University, El-Shatby, 22 El-Guish Road, Alexandria, 21526, Alexandria, Egypt
- Ekbal Hospital, 10 Hassan Amin Street, Alexandria, Egypt
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Ushijima H, Hida JI, Haeno M, Koda M, Ueda K, Kawamura J. Successful treatment of intractable chylous ascites after laparoscopic low anterior resection using lymphangiography and embolization with lipiodol: A case report. Int J Surg Case Rep 2021; 84:106064. [PMID: 34153695 PMCID: PMC8225989 DOI: 10.1016/j.ijscr.2021.106064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Chylous ascites (CA) is an infrequent, intractable complication that may arise after abdominal surgery. Although various attempts at treatment have been adopted, to date, none of them have been consistently effective. We describe the successful treatment of CA using lymphangiography and embolization with lipiodol. CASE PRESENTATION A 79-year-old woman underwent laparoscopic surgery for rectum cancer at another hospital. She was discharged on postoperative day (POD) 9; however, she had to be treated and hospitalized for CA three times until POD 76. She visited our hospital to undergo treatment for CA on POD 90 because the previous conservative treatment had not improved her condition. The computed tomography (CT) scans revealed ascites effusion. We performed lymphangiography and embolization with lipiodol two times. Repeated CT on POD 134 showed that the ascites had not increased. CLINICAL DISCUSSION Lymphangiography and embolization with lipiodol effectively resolved chylous leakage that occurred after abdominal surgery. Additionally, we compare the features of two groups of cases of CA: one group in which patients were treated by lymphatic intervention and the second in which patients were treated through surgical procedures. CONCLUSION We were thus able to demonstrate the clinical effectiveness of lipiodol lymphangiography in treating CA.
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Affiliation(s)
- Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan.
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Masahiro Haeno
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Masashi Koda
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
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Lee AHH, Gillespie C, Johnson MA. Laparoscopic management of chylous ascites posthiatal hernia repair with Toupet fundoplication. J Minim Access Surg 2019; 16:421-423. [PMID: 31793456 PMCID: PMC7597883 DOI: 10.4103/jmas.jmas_198_19] [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] [Indexed: 11/04/2022] Open
Abstract
We present a case of chylous ascites in a 69-year-old man 5 months after a laparoscopic Toupet fundoplication (posterior 270°). This was successfully treated with laparoscopic ligation of tissue adjacent to the right crus. Laparoscopic ligation is a management option that should be considered after this rare complication, offering rapid results.
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Affiliation(s)
- Adele Hwee Hong Lee
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Carla Gillespie
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mary Ann Johnson
- Upper Gastrointestinal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
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