CHYLOUS ASCITES AFTER LAPAROSCOPIC LIVING DONOR NEPHRECTOMY. CASE REPORT AND REVIEW OF THE LITERATURE

Introduction: Chylous ascites is a rare complication after laparoscopic donor nephrectomy (LDN). The management of these patients is controversial and has been changing in the last years. Material and Methods: We report the first case of chylous ascites at our institution and review the literature for the possible treatments (conservative vs surgical). Results: A 51 year old female living kidney donor, with a negative past medical history underwent a left hand-assisted laparoscopic nephrectomy with an uneventful post-operative course. She was discharged home on postoperative day (POD) IV on perfect conditions. On POD IX she was readmitted with fever and abdominal pain. Abdominal CT showed a big fluid collection in the nephrectomy site. A percutaneous drain was inserted and due to high output she underwent a re-exploration the next day. Treatment consisted of clipping of the open limphatic ducts, fibrin sealant application and abdominal drain positioning. Postoperatively, the patient was treated with a nil by mouth regimen, octreotide and progressive low-fat diet. She was discharged on POD 14 in satisfactory conditions. The incidence of chylous ascites in our centre is curently 1/98 (1.02%). Conclusion: Chylous ascites is an uncommon complication after LDN. There are no guidelines available for its management. Conservative treatment can be the first line option, but surgical approach must be considered in case of high volume and/or refractary ascites in order to avoid malnutrition, immunodeficiency and donor psychological discomfort.