Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.

The purpose of this retrospective study was to evaluate the occurrence of infectious complications and inflammatory reactions after transabdominal lymphatic-interventions. 63 lymphatic-interventions were performed in 60 patients (male/female: 35/25; mean age 56 [9-85] years) [chylothorax n = 48, chylous ascites n = 7, combined chylothorax/chylous ascites n = 5]. Post-interventional clinical course and laboratory findings were analyzed in the whole cohort as well as subgroups without (group A; n = 35) and with peri-interventional antibiotics (group B; n = 25) (pneumonia n = 16, drainage-catheter inflammation n = 5, colitis n = 1, cystitis n = 1, transcolonic-access n = 2). No septic complications associated with the intervention occurred. Leucocytes increased significantly, peaking on post-interventional day-1 (8.6 ± 3.9 × 106 cells/mL vs. 9.8 ± 4.7 × 106 cells/mL; p = 0.009) and decreased thereafter (day-10: 7.3 ± 2.7 × 106 cells/mL, p = 0.005). CRP-values were pathological in 89.5% of patients already at baseline (40.1 ± 63.9 mg/L) and increased significant on day-3 (77.0 ± 78.8 mg/L, p < 0.001). Values decreased thereafter (day-15: 25.3 ± 34.4 mg/L, p = 0.04). In subgroup B, 13/25 patients had febrile episodes post-interventionally (pneumonia n = 11, cystitis n = 1, drainage-catheter inflammation n = 1). One patient developed biliary peritonitis despite continued antibiotics and underwent cholecystectomy. Baseline leucocytes and CRP-levels were higher in group B than A, but with comparable post-interventional profiles. Clinically relevant infectious complications associated with transabdominal lymphatic-interventions are rare irrespective of peri-interventional antibiotic use. Post-interventional elevation of leucocytes and CRP are observed with normalization over 10-15 days.

BACKGROUND Chylous ascites (chyloperitoneum), a condition arising from lymphatic leakage in the peritoneal cavity, is rare in liver cirrhosis patients, accounting for less than 1% of cases. Treatment typically involves therapeutic paracentesis, dietary modifications, a low-fat, high-protein diet, and medium-chain triglyceride (MCT) supplementation. Orlistat, a fat absorption inhibitor, has been reported to show potential efficacy in treating chylous ascites. CASE REPORT We detail the case of a 59-year-old male patient admitted for decompensated liver disease and worsening ascites. Diagnostic paracentesis identified chylous ascites, indicated by a 3.5 mmol/L triglyceride level. Despite administering therapeutic paracentesis, dietary modifications, MCT supplementation, Spironolactone, and Terlipressin for a presumed hepatorenal syndrome, the patient\'s ascites remained chylous for two weeks. On administering orlistat, a significant reduction in ascites volume and chylous content was observed, with triglyceride levels dropping to 0.7 mmol/L. CONCLUSIONS Our case illustrates the potential of orlistat in managing chylous ascites in liver cirrhosis patients, marking only the second such case reported in the existing literature. It encourages further exploration of orlistat\'s therapeutic potential in treating chylous ascites.

UNASSIGNED: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment.
UNASSIGNED: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson-Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage.
UNASSIGNED: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.

OBJECTIVE: This retrospective study was designed to evaluate risk factors of occurrence and severity of chylous ascites after complete mesocolic excision (CME) and D3 lymphadenectomy in patients with right-sided colon cancer.
METHODS: Consecutive colorectal cancer patients receiving CME and D3 lymphadenectomy for right-sided colon cancer were included. Risk factors of occurrence and severity of chylous ascites by using logistic analysis were assessed. A nomogram predicting chylous ascites was constructed.
RESULTS: Among 661 patients included, postoperative chylous ascites occurred in 48 (7.3%) patients. Logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 47, OR = 2.172, P = 0.016), laparoscopic surgery (OR = 2.798, P = 0.034), operating time (> 225min, OR = 2.645, P = 0.002), and apical lymph node (APN) metastasis (OR = 3.698, P = 0.034) were correlated with the occurrence of postoperative chylous ascites. A nomogram predicting postoperative chylous ascites was constructed (C-index 0.701). 31.2% (15/48) of patients with chylous ascites were resolved in more than 7 days. The number of retrieved lymph nodes (OR = 1.074, 95% CI: 1.002-1.152, P = 0.044) and PNI ≤ 47 (OR = 7.890, 95% CI: 1.224-50.869, P = 0.030) were independently predictive of prolonged chylous ascites resolution (≥ 7 days).
CONCLUSIONS: In our series, 7.3% of patients developed chylous ascites after right hemicolectomy with CME. Laparoscopic surgery, PNI, operation time, and APN metastasis were independently predictive of postoperative chylous ascites. Lower PNI and more retrieved lymph nodes were correlated with prolonged resolution of chylous ascites.

For evaluation of a novel surgical procedure for the treatment of chylous ascites. Chylous ascites is a debilitating condition associated with high morbidity and mortality rates. At least one-third of patients are refractory to medical therapy and may warrant further treatment. Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging.
A novel flap based on deep inferior epigastric vessels with its surrounding lymphatic fatty tissue was designed in this study and transferred into abdominal cavity, with anastomosis to the fourth jejunal vessels. Three consecutive cases with chylous ascites treated by this vascularized lymphatic cable transfer were retrospectively reviewed.
All three patients recovered from chylous ascites after the lymphatic cable transfer and tolerated regular diet well, with follow-up of 3 years at least.
Lymphatic cable flap based on the deep inferior epigastric vessels could be a potential option for treatment of intractable chylous ascites, with safe and successful long-term outcomes in three consecutive patients. The proposed functional mechanism of the flap is bypass of the obstructed intra-abdominal lymphatics to an extraperitoneal route as well as local lymphangiogenesis.

Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available.
The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation.
Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality.
This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.

BACKGROUND: Although enhanced recovery programs (ERPs) have been proven to be beneficial after laparoscopic colon surgery, they may result in adverse clinical outcomes following failure. This study analyzed risk factors associated with ERP failure after laparoscopic colon cancer surgery.
METHODS: We analyzed the outcomes of 208 patients who underwent ERPs following laparoscopic colon cancer surgery between June 2007 and April 2013. The ERP included early oral feeding, early ambulation, and regular laxative administration. ERP failure was defined as postoperative hospital stay of more than 5 days related to postoperative complications, unplanned readmission within 30 days of surgery, or death.
RESULTS: Surgical procedures included anterior resection (n = 101), right hemicolectomy (n = 90), and left hemicolectomy (n = 17). The mean postoperative hospital stay was 6.5 ± 2.3 days (range 3-24 days). ERP failure occurred in 36 patients (17.3%), with no mortality; reasons included ileus (n = 14), wound infection (n = 4), chylous drainage (n = 3), anastomotic bleeding (n = 3), pneumonia (n = 1), or readmission (n = 11) owing to delayed complications. Univariable analysis showed that ERP failure was associated with proximal colon cancer, side-to-side anastomosis, longer operation time, increased blood loss, and longer resected specimen length. Multivariable analysis showed that side-to-side anastomosis [odds ratio (OR) 4.534; 95% confidence interval (CI) 1.902-10.811; P = 0.001] and increased blood loss (OR 1.004; 95% CI 1.001-1.008; P = 0.041) were independent risk factors for ERP failure.
CONCLUSIONS: We showed that increased blood loss and side-to-side anastomosis in comparison with end-to-end anastomosis were independent risk factors associated with ERP failure after laparoscopic colon cancer surgery. This suggests that intraoperative elements may be important determinants to obtain successful postoperative recovery in the era of ERP.

This retrospective study was carried out at eight Neonatal Intensive Care Units (NICU) Centers worldwide on 33 newborns presenting at birth with pleural, pericardial, or abdominal chylous effusions. Diagnosis of chylous effusion is based on findings of fluid with a milk-like appearance, a concentration of triglycerides in pleural effusion >1.1 mmol/l, and a total cell count >1,000 cells/ml with a predominance of >80% lymphocytes. Thirty-three newborns met the inclusion criteria and were studied. Six subjects who presented at birth with fetal effusion were treated by in-utero pleuro-amniotic shunt. Five of these patients are alive at follow-up. At birth, pleural drainage was performed in 29/33 patients and abdominal drainage was carried out in 3/33. Total parenteral nutrition (TPN) was given to 32/33 patients; 19/23 patients were fed a medium-chain triglycerides (MCT). No adverse effects were observed. Eight patients were treated with Octreotide at dosages ranging from 1 to 7 mcg/kg/hour for 8 to 35 days. All patients showed decreased chylous production. Two patients were treated by pleurodesis. Twenty-two babies are alive after at least 6 months follow-up, 9/33 are deceased, and 2 were lost to follow-up. Clinical conditions of survivors are basically good except for lung involvement [chronic lung disease (CLD) or lung lymphangiectasia] and lymphedema. All patients were using a MCT diet at follow-up with good control of chylous effusion. Visceral chylous effusions of the fetus and neonate are rare disorders, and there currently is only partial agreement on decision-making strategies. We suggest the need for an international prospective trial in an effort to establish the efficacy and effectiveness of diagnostic and therapeutic options described in this article.

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