Postoperative Chyle Leak After Major Pancreatic Resections in Patients Who Receive Enteral Feed: Risk Factors and Management Options
- 8 October 2013
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 37 (12), 2918-2926
- https://doi.org/10.1007/s00268-013-2171-x
Abstract
Chyle leak complicates 1.3–10.8 % of pancreatic resections. Universal use of parenteral nutrition following pancreatic resection may reduce the incidence of chyle leak. However, this denies the majority of patients who do not develop chyle leak the benefits of enteral nutrition (EN). The present study aimed to identify risk factors for chyle leak following pancreatic resection within a single institution where EN was used universally. All patients who underwent pancreatic resection between January 2007 and December 2010 were identified retrospectively. The patients had been treated according to a common unit protocol of enteral feeding; those developing chyle leak were switched to a medium-chain triglyceride (MCT) regimen. Clinical progress and recovery after surgery was evaluated. Multivariate analysis was performed to identify factors associated with chyle leak. A total of 245 patients underwent major pancreatic resection (231 pancreatoduodenectomy, 14 total pancreatectomy). Chyle leak complicated 40 cases (16.3 %). After multivariate analysis, both extensive lymphadenectomy (P = 0.002) and postoperative portal/mesenteric venous thrombosis (PVT) (P = 0.009) were independently linked with a higher incidence of chyle leak. The development of chyle leak was not associated with poorer survival or prolonged duration of hospital stay. It was associated with a significantly increased duration of abdominal drainage and reduced likelihood of early hospital discharge (P = 0.026). Universal use of enteral feeding is associated with a high rate of chyle leak following pancreatic resection. Patients undergoing extensive lymphadenectomy or those who develop PVT postoperatively are at increased risk. Development of chyle leak was not associated with additional morbidity or mortality following implementation of an MCT regimen. The implication is that reactive management of chyle leak with conversion to a MCT predominant diet is safe.Keywords
This publication has 30 references indexed in Scilit:
- Feeding Patients Following Pancreaticoduodenectomy: A UK National SurveyThe Annals of The Royal College of Surgeons of England, 2009
- Chyle Leaks: Consensus on Management?Nutrition in Clinical Practice, 2008
- Beneficial Effect of Enteral FeedingGastrointestinal Endoscopy Clinics of North America, 2007
- Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management OptionsDigestive Surgery, 2007
- THE DIAGNOSIS AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITESJournal of Urology, 2002
- Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trialThe Lancet, 2001
- Artificial nutrition after major abdominal surgeryCritical Care Medicine, 1998
- CHYLOUS ASCITES AFTER LIVER TRANSPLANTATIONTransplantation, 1994
- Management of Retroperitoneal Chylous LeakageSpine, 1994
- Chylous Ascites following Retroperitoneal Lymph Node Dissection for Testis CancerPublished by Wiley ,1992