Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.246
Peer-review started: June 17, 2015
First decision: August 24, 2015
Revised: September 5, 2015
Accepted: December 13, 2015
Article in press: December 15, 2015
Published online: March 27, 2016
AIM: To investigate changes over time in, and effects of sealing technology on, milk test results following pancreatectomy.
METHODS: From April 2008 to October 2013, 66 pancreatic resections were performed at the Iwakuni Clinical Center. The milk test has been routinely conducted at the institute whenever possible during pancreatectomy. The milk test comprises the following procedure: A nasogastric tube is inserted until the third portion of the duodenum, followed by injection of 100 mL of milk through the tube. If a chyle leak is present, the patient tests positive in this milk test based on the observation of a white milky discharge. Positive milk test rates, leakage sites, and chylous ascites incidence were examined. LigaSure™ (LS; Covidien, Dublin, Ireland), a vessel-sealing device, is routinely used in pancreatectomy. Positive milk test rates before and after use of LS, as well as drain discharge volume at the 2nd and 3rd postoperative days, were compared retrospectively. Finally, positive milk test rates and chylous ascites incidence were compared with the results of a previous report.
RESULTS: Fifty-nine milk tests were conducted during pancreatectomy. The positive milk test rate for all pancreatectomy cases was 13.6% (8 of 59 cases). One case developed postoperative chylous ascites (2.1% among the pancreatoduedenectomy cases and 1.7% among all pancreatectomies). Positive rates by procedure were 12.8% for pancreatoduodenectomy and 22.2% for distal pancreatectomy. Positive rates by disease were 17.9% for pancreatic and 5.9% for biliary diseases. When comparing results from before and after use of LS, positive milk test rates in pancreatoduodenectomy were 13.0% before and 12.5% after, while those in distal pancreatectomy were 33.3% and 0%. Drainage volume tended to decrease when LS was used on the 3rd postoperative day (volumes were 424 ± 303 mL before LS and 285 ± 185 mL after, P = 0.056). Both chylous ascites incidence and positive milk test rates decreased slightly compared with those rates from the previous study.
CONCLUSION: Positive milk test rates and chylous ascites incidence decreased over time. Sealing technology may thus play an important role in preventing postoperative chylous ascites.
Core tip: Chylous ascites is sometimes a severe complication of pancreatectomy. We previously reported that the milk test could serve to prevent chylous ascites following surgery. In this study, changes over time in milk test results, and effects of new energy devices on the test results, were investigated. Compared with the first report results, positive milk test rates and chylous ascites incidence were found to have decreased slightly. Use of the new energy devices also tended to result in decreased drainage volume. These findings suggest that the vessel-sealing technology could play an important role in preventing postoperative chylous ascites.