BACKGROUND: Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches. METHODS: A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model. RESULTS: Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS. CONCLUSIONS Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.
Chylous Ascites/etiology* ; Humans ; Incidence ; Laparoscopy ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/adverse effects*

Chyle only occurs in the peritoneal cavity or around the pericardium through damage to the lymph nodes or improper drainage of the lymph and is characterized by a colostrum-like color and being rich in triglyceride. We encountered a case of a newborn infant with abdominal distention and further diagnosed chylous ascites and hydrocele by inspecting and analyzing the fluid obtained from the abdominal cavity and scrotum. Additionally, a lymphoscintigraphy was performed, which showed a decrease in the uptake of radioactive isotopes in the left iliac nodes and a delayed appearance. Here, we report a case of chyle diagnosed through puncture analysis and its subsequent successful treatment.
Abdominal Cavity ; Chyle ; Chylous Ascites ; Drainage ; Humans ; Infant, Newborn ; Lymph Nodes ; Lymphoscintigraphy ; Pericardium ; Peritoneal Cavity ; Punctures ; Radioisotopes ; Scrotum ; Triglycerides

With improving survival of children with complex congenital heart disease (CCHD), postoperative complications, like protein-losing enteropathy (PLE) are increasingly encountered. A 3-year-old girl with surgically corrected CCHD (ventricular inversion/L-transposition of the great arteries, ventricular septal defect, pulmonary atresia, post-double switch procedure [Rastelli and Glenn]) developed chylothoraces. She was treated with pleurodesis, thoracic duct ligation and subsequently developed chylous ascites and PLE (serum albumin ≤0.9 g/dL) and was malnourished, despite nutritional rehabilitation. Lymphangioscintigraphy/single-photon emission computed tomography showed lymphatic obstruction at the cisterna chyli level. A segmental chyle leak and chylous lymphangiectasia were confirmed by gastrointestinal endoscopy, magnetic resonance (MR) enterography, and MR lymphangiography. Selective glue embolization of leaking intestinal lymphatic trunks led to prompt reversal of PLE. Serum albumin level and weight gain markedly improved and have been maintained for over 3 years. Selective interventional embolization reversed this devastating lymphatic complication of surgically corrected CCHD.
Adhesives ; Arteries ; Cardiac Surgical Procedures ; Child ; Child, Preschool ; Chyle ; Chylous Ascites ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Ligation ; Lymphatic Abnormalities ; Lymphography ; Pleurodesis ; Postoperative Complications ; Protein-Losing Enteropathies ; Pulmonary Atresia ; Rehabilitation ; Serum Albumin ; Thoracic Duct ; Tomography, Emission-Computed ; Weight Gain

No abstract available.
Chylous Ascites ; Lymphoma, Follicular

Chylous ascites is a rare complication following bariatric surgeries. Little data is available regarding chylous ascites following bariatric surgeries per se or in association with internal hernias. Herein we present two cases of chylous ascites following Roux-En-Y gastric bypass; the first one is a 60-year-old male who was presented to the ER six months after a gastric bypass operation suffering from abdominal pain, CT scan and upper endoscopy were normal, however chylous ascites and internal hernia were found during exploratory laparoscopy. The second case is a 39-year-old female patient who was admitted three years following the gastric bypass operation and diagnosed to have small bowel obstruction due to internal hernia, and during exploratory laparoscopy a chylous ascites was found.
Abdominal Pain ; Adult ; Bariatric Surgery ; Chylous Ascites ; Endoscopy ; Female ; Gastric Bypass ; Hernia ; Humans ; Laparoscopy ; Male ; Middle Aged ; Tomography, X-Ray Computed

Umbilical venous catheterization (UVC) is a common practice in intensive neonatal care. However, a malpositioned UVC and its prolonged use may lead to various problems, including mechanical, infectious, and thrombotic complications in various organs such as the liver, lungs, and heart. Congenital chylous ascites is characterized by abnormally high levels of triglycerides in the peritoneal fluid of newborns, which originate from refluxed lymph within the abdominal cavity. Herein, we report a case of an UVC complication presenting as chyloperitoneum simulating congenital chylous ascites in a preterm neonate that resulted from total parenteral nutrition (TPN) extravasation from a malpositioned UVC. Biochemical analysis of intraperitoneal chylous fluid and TPN infusate could help confirm the origin of chyloperitoneum. This case suggests that TPN extravasation from UVC should be considered when chyloperitoneum develops in newborns with an indwelling catheter. UVC positions must also be carefully monitored at regular intervals to recognize associated complications early, particularly in cases with an inevitably malpositioned catheter related to the anatomy of the vessel course.
Abdominal Cavity ; Ascitic Fluid ; Catheterization ; Catheters* ; Catheters, Indwelling ; Chylous Ascites* ; Heart ; Humans ; Infant, Newborn* ; Liver ; Lung ; Parenteral Nutrition, Total* ; Triglycerides

Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.
Aged ; Ascites ; Chemistry ; Chylothorax* ; Chylous Ascites* ; Female ; Hepatic Encephalopathy ; Hepatitis B ; Humans ; Liver Cirrhosis ; Pleural Effusion ; Pleurodesis ; Thoracic Duct

OBJECTIVETo compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.

METHODSClinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.

RESULTSA total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].

CONCLUSIONSMorbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak ; epidemiology ; etiology ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrovascular Disorders ; epidemiology ; etiology ; Chylous Ascites ; epidemiology ; etiology ; Comorbidity ; Comparative Effectiveness Research ; Duodenal Diseases ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Gastroscopy ; Hemoperitoneum ; epidemiology ; etiology ; Humans ; Intestinal Fistula ; epidemiology ; etiology ; Intraabdominal Infections ; epidemiology ; etiology ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Postoperative Hemorrhage ; epidemiology ; etiology ; Postoperative Period ; Respiratory Tract Infections ; epidemiology ; etiology ; Retrospective Studies ; Risk Assessment ; Robotic Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery ; Surgical Wound Infection ; epidemiology ; etiology

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards

Massive chylous leakage is a rare postoperative complication that can prolong hospital stay and cause secondary morbidities. Conservative management strategies are the treatment of choice; however, radiation therapy (RT) can be used as an alternative for cases that are refractory to conservative treatment. Herein, we report a 69-year-old female patient who suffered from massive chylous leakage after subtotal gastrectomy. Due to persistent massive chylous leakage, she was scheduled to undergo low-dose RT. Radiation was delivered with a daily dose of 1 Gy, using an anterior-posterior and posterior-anterior beam arrangement. The clinical target volume encompassed the entire lymph node area of the D2 dissection. RT was completed at the total dose of 8 Gy because the amount of chylous leakage declined rapidly. Percutaneous drainage tube was removed after 3 days of RT. The patient did not complain of any symptoms related to massive chylous leakage 2 years after the completion of RT.
Aged ; Chylous Ascites ; Drainage ; Female ; Gastrectomy* ; Humans ; Length of Stay ; Lymph Nodes ; Postoperative Complications ; Radiotherapy