Chylous Ascites After Laparoscopic Lymph Node Dissection in Gynecologic Malignancies

Study Objective: To evaluate the clinical presentation, epidemiology, risk factors, and treatment of chylous ascites after laparoscopic lymphadenectomy to treat gynecologic malignancies. Design: Retrospective study with review of outcomes (Canadian Task Force classification II-3). Setting: University research hospital. Patients: From November 2009 to December 2012, 997 patients underwent laparoscopic lymphadenectomy to treat gynecologic malignancies at our hospital. Interventions: Postoperative chylous ascites resolved with continuous drainage and dietary restriction or fasting. Measurements and Main Results: Nine of 997 patients (0.9%) developed chylous ascites postoperatively. Mean age of these 9 patients was 47.5 years. Median time from operation to development of chylous ascites was 4 days (range, 2-9 days). Chylous ascites developed on either day 1 in 6 patients, day 2 in 2 patients, and day 8 in 1 patient, after food intake. We found that postoperative chylous ascites was associated more with para-aortic lymphadenectomy than with pelvic lymphadenectomy (overall incidence, 0.9%; 4.08% in the para-aortic lymphadenectomy group vs 0.35% in the pelvic lymphadenectomy group). In all patients, chylous ascites resolved with conservative treatment. Median time to resolution was 7 days (range, 3-9 days). Drainage tubes were removed within 9 days after treatment. Conclusions: The incidence of chylous ascites after laparoscopic lymphadenectomy was 0.9%. Para-aortic lymphadenectomy was associated with postoperative chylous ascites. Chylous ascites was successfully treated with conservative management. An abdominal drainage tube can be a simple and effective approach and should be considered in the treatment of chylous ascites. (C) 2014 AAGL. All rights reserved.