“Chylous Ascites: Complication of laparoscopic donor nephrectomy. Case Report and review of literature.”

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 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, 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 till date. Around 77% donors with CA could be successfully managed conservatively with dietary measures and total parentral 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. While conservative management remains the first line of treatment, early surgical treatment shall be undertaken in cases of massive ascites. Corresponding Author: Sarbpreet Singh, Assistant Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector -12, Pin code: 160012, Chandigarh, India. Email: drsarbpreetsingh@yahoo.com Authorship Page Authors: Abhinav Seth, Ashish Sharma, Deepesh Benjamin Kenwar, Sarbpreet Singh, Abhinav Seth, M.S. General Surgery, Senior Resident, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: drabhinavseth@gmail.com Contribution: Participated in research design, writing of paper and data analysis. Ashish Sharma, M.S. General Surgery, Professor and Head, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: ashish_chd@hotmail.com Contribution: Participated in research design. Deepesh Benjamine Kenwar, Additional Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: deepesh.doc@gmail.com Contribution: Participated in the performance of the research Sarbpreet Singh (Corresponding author), Assistant Professor, Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Sector-12, Pin Code: 160012, Chandigarh, India. Email: drsarbpreet@yahoo.com Contribution: Participated in research design, writing of paper and data analysis Disclosure: The authors declare no conflict of interests. Funding: The authors did not receive any funding for this manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QpGkol