A Proposed Classification System and Therapeutic Strategy for Chyle Leak after Laparoscopic Live Donor Nephrectomy: A Single-centre Experience and Review of Literature

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IntroductionChyle leak (CL) or chylous ascites (CA) remains a rare complication after laparoscopic live donor nephrectomy (LDN). Its aetiology and management have not been well elucidated in the literature. Thus, the aim of this study is to review the incidence of CL/CA after LDN in our institute and the literature to propose a classification system with its associated treatment strategy.Material and MethodsA retrospective review of LDN cohort from January 2005 to April 2016 to identify CL/CA along with the management was conducted. A proposed classification system is described based on our experience and literature.ResultsCL developed in 4 donors (2.25%). Of the four, three were managed non-operatively with diet modification and subcutaneous octreotide injection. One case required surgical intervention after failure with conservative treatment.ConclusionCL/CA is rare after LDN but delayed diagnosis may lead to morbidity secondary to malnutrition and immunosuppression. Meticulous surgical dissection is essential to seal the lymphatic tubes during LDN. A proposed classification system will provide a guidance for management of CL and improve the outcome of recovery.

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