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World J Clin Urol. Mar 24, 2016; 5(1): 37-44
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.37
Chylous ascites in laparoscopic renal surgery: Where do we stand?
Bum Soo Kim, Tae Gyun Kwon
Bum Soo Kim, Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41944, South Korea
Tae Gyun Kwon, Department of Urology, Chilgok Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41404, South Korea
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tae Gyun Kwon, MD, PhD, Department of Urology, Chilgok Kyungpook National University Hospital, Kyungpook National University School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu 41404, South Korea. tgkwon@knu.ac.kr
Telephone: +82-53-2003516 Fax: +82-53-4219618
Received: August 26, 2015
Peer-review started: August 31, 2015
First decision: November 27, 2015
Revised: November 30, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: March 24, 2016
Processing time: 204 Days and 22.4 Hours
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.

Keywords: Chylous ascites; Kidney; Laparoscopy; Nephrectomy; Postoperative complications

Core tip: Now that laparoscopic renal surgery is widely performed, postoperative chylous ascites is encountered more frequently. Although most cases can be managed conservatively without any critical sequelae, severe refractory cases may cause malnutrition and immunological deficiency and require interventional treatment. To overcome this complication, early diagnosis and proper choice of management strategies are necessary. Moreover, understanding the mechanism of and postoperative chylous ascites preventing its occurrence are the most important factors. Meticulous clipping around the great vessels and the use of hemostatic agents during laparoscopic nephrectomy can reduce the incidence of postoperative chylous ascites.