Figure - available via license: Creative Commons Attribution 3.0 Unported
Content may be subject to copyright.
Source publication
Introduction. Donor workup in renal transplantation is extensive. Despite this, chyle leakage following donor nephrectomy, a rare complication, has been reported in the literature. We encountered two cases of chyle leak in kidney donors in our series of open donor nephrectomies. Summary of Cases. After complete workup, standard open retroperitoneal...
Citations
... Chylous ascites refers to the accumulation of chyle in the abdominal cavity. There are few reports of chylous ascites following donor nephrectomy [3][4][5][6][7] of which two were associated with open nephrectomy [5] and remaining cases with LDN. In a study by Harper et al., [8] 750 patients of LDN were analyzed, and only two patients had developed postoperative chylous ascites. ...
... Chylous ascites refers to the accumulation of chyle in the abdominal cavity. There are few reports of chylous ascites following donor nephrectomy [3][4][5][6][7] of which two were associated with open nephrectomy [5] and remaining cases with LDN. In a study by Harper et al., [8] 750 patients of LDN were analyzed, and only two patients had developed postoperative chylous ascites. ...
Chylous ascites refers to the accumulation of chyle in the abdominal cavity. Postoperative chylous ascites is most commonly associated with abdominal aortic surgeries. However, it is a rare complication following laparoscopic nephrectomy. It causes loss of fat, protein, and antibodies causing malnutrition and immunodeficiency. Thus, it is important to treat it as early as possible. We hereby report a case of chylous ascites following laparoscopic donor nephrectomy. A 55-year-old female was admitted at our center 2 weeks after undergoing left laparoscopic donor nephrectomy with abdominal distension and constipation. USG abdomen revealed free fluid in the abdomen. Paracentesis revealed chylous ascites. The patient was started on conservative treatment, including a diet rich in proteins and low in fats; conservative treatment, however, was unsuccessful. Lymphangiography and subsequent embolization of the defect were done, and she made a full recovery.
... Details from the published literature are listed in Table 1. 4,9,10,14,15,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] From an anatomic perspective, the cause of CL is understood due to division of paralymphatic trunks that connect with the intestinal truck to form the cistern chyli at the level of renal hilum during dissection of renal vessels. In LDN, the dissection is adjacent to the aorta to obtain a maximum length of renal vessels for the subsequent kidney transplant. ...
... Details from the published literature are listed in Table 1. 4,9,10,14,15,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] From an anatomic perspective, the cause of CL is understood due to division of paralymphatic trunks that connect with the intestinal truck to form the cistern chyli at the level of renal hilum during dissection of renal vessels. In LDN, the dissection is adjacent to the aorta to obtain a maximum length of renal vessels for the subsequent kidney transplant. ...
Objectives:
Chyle leak or chylous ascites remains a rare complication after laparoscopic living-donor nephrectomy. Its cause and management have not been well elucidated in the literature. Thus, the aim of this study was to review the incidence of chyle leak/chylous ascites after laparoscopic living-donor nephrectomy in our institute and in the literature to propose a classification system with its associated treatment strategy.
Materilas and methods:
In this retrospective review of laparoscopic living-donor nephrectomy patients from January 2005 to April 2016, we identified patients with chyle leak/chylous ascites along with the care performed. A proposed classification system based on our experience and literature is described.
Results:
Chylous leak developed in 4 donors (2.25%). Of the 4 donors, 3 were treated nonoperatively with diet modification and subcutaneous octreotide injection. One patient required surgical intervention after not responding to second-line therapy with total parenteral nutrition.
Conclusions:
Chyle leak/chylous ascites after laparoscopic living-donor nephrectomy is rare, but a delayed diagnosis may lead to morbidity secondary to malnutrition and immunosuppression. Meticulous surgical dissection is essential to seal the lymphatic tubes during laparoscopic living-donor nephrectomy. The proposed classification system provides a practical and tailored guide to management based on the drainage volume of chyle leak and a guide to the earlier identification of refractory cases.
... 3 There is a growing number of reports of chylous ascites following donor nephrectomy, with the majority of these occurring after laparoscopic procedures. On review of the literature, we found a total of 57 cases of chylous ascites 4-8 of which two were associated with open procedures 6 and one following robot assisted LDN. 4 It is interesting to note that all the reports of chylous ascites identified were associated with left laparoscopic nephrectomy. Meulen et al. 5 hypothesise that the proximity of ligation of the renal artery to the aorta may be the cause for this. ...
We report a case of chylous ascites following a hand
assisted laparoscopic donor nephrectomy (HALDN). In this
case a 70-year-old male was re-admitted three weeks after
undergoing a left HALDN with anorexia and abdominal
distension. Abdominal CT confirmed ascites. Paracentesis
yielded five litres of chylous fluid. He was treated conservatively with a high protein, low fat diet and made a
full recovery. The management of this complication remains
controversial with some advocating early surgical intervention and others preferring conservative management techniques. Consideration must be given to early surgical intervention in cases not responding immediately to conservative measures.
... Iatrogenic lymphatic injury related to kidney transplantation is extremely rare. 7,8 This case highlights the usefulness of nuclear medicine studies in the diagnosis of chyle leakage, a rare yet important complication. ...
Iatrogenic chyle leak with chyloma formation is a rare complication of kidney transplantation resulting from injury to the lymphatics. We present a case of a 53-year-old man who complained of right leg swelling 2 months after kidney transplantation for chronic renal failure. Abdomen CT showed loculated fluid collection around the transplanted kidney. Lymphoscintigraphy demonstrated chyle leak in the right iliac fossa, and subsequent ultrasound-guided aspiration of the chyloma showed radioactivity as detected by gamma camera. After drainage insertion, the amount of collected fluid gradually decreased, and right leg edema was relieved.
Chyle leak after living donor nephrectomy is a rare complication and is associated with a significant postoperative burden. To the best of our knowledge, only 1 case of chyle leak after robotic living donor nephrectomy has been reported in the literature. In this study, we present our experience with 2 cases of chyle leak: 1 after and 1 during robotic donor nephrectomy. We discuss previously published studies and man - agement options of chyle leak in kidney donors.
