Chylous ascites following laparoscopic living donor nephrectomy


COD: 06_2011_499-504-1 Categorie: ,

Massimiliano Gagliano, Pierfrancesco Veroux, Daniela Corona, Matteo Angelo Cannizzaro, Giuseppe Giuffrida, Alessia Giaquinta, Massimiliano Veroux

Ann. Ital. Chir., 2011; 82: 499-503

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Kidney transplantation is a therapeutic option of choice for patients with end-stage disease. Laparoscopic living donor
nephrectomy (LLDN) is a less invasive alternative to the open procedure to increase the number of renal donors. However,
several studies have reported that this technique requires a long learning curve, and that the complication rate varies
from 6.4% to 16.5%. Among these, chylous ascites (CA) is a severe and rare complications of LLDN. The treatment
option for this condition is primari1y conservative. Surgery is considered after failure of conservative treatment and its
role, however, remains controversial. We report a case of CA as a complication of laparoscopic donor nephrectomy. A 44
year old woman underwent LLDN of the left kidney. There were no intraoperative or immediate postoperative complications
and the patient was discharged home on postoperative day 3. Two weeks after discharge, the patient returned
for a routine follow-up visit and presented with abdominal distension, discomfort, and dyspnea. A CT scan of the abdomen
with oral and intravenous contrast revealed significant ascites in all four quadrants of abdomen and pelvis. An
ultrasound guided paracentesis was performed, and 7 L of chyle was aspirated. Conservative management with medium
chain triglyceride and spironolactone was immediately initiated; the symptoms improved after paracentesis, and the CA
completely resolved after 3 days of therapy. However, to prevent recurrence, the patient consumed a low -fat medium
chain triglyceride diet for 6 months. CA needs to be considered as a potential severe and rare complication of LLDN,
and conservative management should be proposed to all patients, reserving the surgical treatment to treatment failure.


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