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Drainage Volume After Pancreaticoduodenectomy Is a Warning Sign of Chyle Leakage That Inversely Correlates With a Diagnosis of Pancreatic Fistula

Authors
 Jae Keun Kim ; Joon Seong Park ; Dong Sup Yoon ; Hyun Wook Shin ; Ho Kyoung Hwang 
Citation
 World Journal of Surgery, Vol.37(4) : 854~862, 2013 
Journal Title
 World Journal of Surgery 
ISSN
 0364-2313 
Issue Date
2013
Abstract
BACKGROUND: Chyle leakage is a rare complication of pancreaticoduodenectomy (PD), and its association with pancreatic fistula has not been established. The aim of this study was to (1) evaluate the incidence, management, and risk factors of chyle leakage after PD; (2) determine if there is a relation between chyle leakage and diagnosis of pancreatic fistula; and (3) predict chyle leakage with drainage volume early. METHODS: A total of 222 patients underwent PD or pylorus-preserving PD. We used the clinical database registry system of the Gangnam Severance Hospital, Yonsei University Health System to establish a retrospective cohort with clinicopathologic data. RESULTS: Altogether, 24 patients (10.8 %) developed chyle leakage. Chyle leakage was identified at a median 5 days after surgery and a mean 2 days after enteral intake. The mean drain triglyceride level was 315 mg/dl. Early enteral intake was independently associated with chyle leakage. Chyle leakage was inversely correlated with a diagnosis of pancreatic fistula with marginal significance (odds ratio 0.27; 95 % confidence interval 0.66-1.09). The receiver operating characteristic curve of the volume on postoperative day 4 demonstrated an area under the curve of 0.740 (p = 0.0001). Drainage >335 ml indicated possible chyle leakage. CONCLUSIONS: Chyle leakage after PD is associated with early enteral intake. It was inversely correlated with a diagnosis of pancreatic fistula because of the dilution effect of drainage volume on the concentration of drained amylase. Because early diagnosis helps with appropriate management, prediction/suspicion of chyle leakage based on drainage volume may be useful.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/87519
DOI
10.1007/s00268-013-1919-7
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Surgery
Yonsei Authors
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Link
 http://link.springer.com/article/10.1007%2Fs00268-013-1919-7
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