Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2021; 13(6): 585-596
Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.585
Chylous ascites in colorectal surgery: A systematic review
Zi Qin Ng, Margaret Han, Han Nien Beh, Simon Keelan
Zi Qin Ng, Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia
Zi Qin Ng, Margaret Han, Han Nien Beh, Simon Keelan, Department of General Surgery, Joondalup Health Campus, Joondalup 6027, Western Australia, Australia
Author contributions: Ng ZQ was responsible for study design, collected and analyzed data, drafted the manuscript; Han M collected and analyzed data and review of manuscript; Beh HN were responsible for date analysis and review of the manuscript; Keelan S was responsible for co-design study, data analysis and critical review of the manuscript; all authors approved the final version of the manuscript to be submitted.
Conflict-of-interest statement: The authors have no conflict of interest or financial ties to disclose.
PRISMA 2009 Checklist statement: The authors confirm that the manuscript was prepared according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi Qin Ng, MBBS, Department of General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland 6056, Western Australia, Australia. kentng@hotmail.co.uk
Received: January 18, 2021
Peer-review started: January 18, 2021
First decision: April 19, 2021
Revised: April 24, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: June 27, 2021
Abstract
BACKGROUND

Chylous ascites is a rare complication in colorectal surgery with limited evidence.

AIM

To systematically review all available evidence to describe the incidence, clinical presentation, risk factors and management strategies.

METHODS

The systematic review was performed through PubMed, MEDLINE, EMBASE and Cochrane and cross-checked up to November 2020. The data collated included: Demographics, indications (benign vs malignant), site of disease, surgical approach, extent of lymphadenectomy, day to and method of diagnosis of chylous ascites and management strategies.

RESULTS

A total of 28 studies were included in the final analysis (426 cases). Patient age ranged from 31 to 89 years. All except one case were performed for malignancy. Of the 426 cases, 195 were right-colonic, 121 left-colonic, 103 pelvic surgeries and 7 others. The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume. Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis. Most cases were managed successfully non-operatively (fasting with prolonged drainage, total parenteral nutrition, somatostatin analogues or a combination of these). Only three cases required surgical intervention after failing conservative management and subsequently resolved completely. Risk factors identified include: Right-colonic surgery/ tumour location, extent of lymphadenectomy and number of lymph nodes harvested.

CONCLUSION

Chylous ascites after colorectal surgery is a relatively rare complication. Whilst the majority of cases resolved without surgical intervention, preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.

Keywords: Chylous, Chyle, Ascites, Leak, Colon, Rectum, Lymphadenectomy

Core Tip: Chylous ascites is a rare entity in colorectal surgery. However, observed rates have increased in recent years in association with increasingly aggressive D3 lymphadenectomy and does carry significant risk of morbidity from malnutrition, electrolytes imbalances and immunosuppression secondary to protein and lymphocyte loss. Therefore, great care should be applied to dissection and control of lymphatics around major vasculature.