Marc G Besselink1, L Bengt van Rijssen2, Claudio Bassi3, Christos Dervenis4, Marco Montorsi5, Mustapha Adham6, Horacio J Asbun7, Maximillian Bockhorn8, Oliver Strobel9, Markus W Büchler9, Olivier R Busch2, Richard M Charnley10, Kevin C Conlon11, Laureano Fernández-Cruz12, Abe Fingerhut13, Helmut Friess14, Jakob R Izbicki8, Keith D Lillemoe15, John P Neoptolemos16, Michael G Sarr17, Shailesh V Shrikhande18, Robert Sitarz19, Charles M Vollmer20, Charles J Yeo21, Werner Hartwig22, Christopher L Wolfgang23, Dirk J Gouma2. 1. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl. 2. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. 4. Department of First Surgery, Agia Olga Hospital, Athens, Greece. 5. Department of Surgery, Humanitas Research Hospital and University, Milan, Italy. 6. Department of HPB Surgery, Hopital Edouard Herriot, HCL, UCBL1, Lyon, France. 7. Department of Surgery, Mayo Clinic, Jacksonville, FL. 8. Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 9. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 10. Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK. 11. Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland. 12. Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain. 13. First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria. 14. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 15. Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA. 16. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. 17. Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN. 18. Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India. 19. Department of Surgical Oncology, Medical University in Lublin, Poland. 20. Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA. 21. Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA. 22. Division of Pancreatic Surgery, Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians University, University of Munich, Germany. 23. Department of Surgery, Johns Hopkins Medicine, Baltimore, MD.
Abstract
BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. RESULTS: Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. CONCLUSION: This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.
BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. RESULTS: Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. CONCLUSION: This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.