Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy
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ORIGINAL ARTICLE
Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy Elin Edda Seland Agustsdottir 1 & Bojan V. Stimec 2 & Tine Tveit Stroemmen 1 & Ariba Ehsan Sheikh 1 & Ilackiya Elaiyarajah 1 & Jonas Christoffer Lindstroem 3 & Dejan Ignjatovic 1,4 Received: 13 April 2020 / Accepted: 14 July 2020 # The Author(s) 2020
Abstract Background We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Methods Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure. Results In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19). Conclusions Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet. Keywords Chylous ascites . D3 extended mesenterectomy . Fat-reduced diet . Fat-free diet . Lymphatic leak
Introduction Small bowel and right colonic neoplasms tend to spread to the central mesentery via the lymph flow. Higher awareness of Highlights • The incidence of chylous ascites after D3 extended mesenterectomy was 41%. • A fat-reduced diet at least 3 days postoperatively reduced the incidence of chylous ascites to 1%. • Average drain fluid was 100–150 mL less per day in the group who ate fat-reduced diet. * Dejan Ignjatovic [email protected]; [email protected] 1
Department of Digestive Surgery, Akershus University Hospital, Lørenskog 1478, Norway
2
Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
3
Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
4
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
this spreading pattern inevitably leads to more extensive surgery. Performing D3 lymph node dissection in the root of the mesentery can lead to injury of the intestinal trunks and subsequent chylous ascites [1]—a well-known but traditionally uncommon complication after surgery. D3 extended mesenterectomy entails the removal of all fatty tissue from the predefin
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