Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

A unique case report is hereby presented which entails the multi-modality management of a very rare complication of modern minimally-invasive robotic surgery. Chyle leak can be an extremely challenging problem following certain surgeries, especially in cancer patients. Medical, nutritional and/or surgical management is required to control the leak. Prolonged massive chyle leaks which do not respond to conservative management require surgical intervention. Retroperitoneal lymph node dissection is a complex procedure undertaken for lymph node clearance in germ cell tumors after primary radical surgery. Robotic surgeries have revolutionized the field of minimally invasive operations. A patient who underwent robotic nerve sparing retroperitoneal lymph node dissection for non-seminomatous germ cell tumor of the right testis, post-chemotherapy, developed a continuous large volume chylous ascites, presenting with electrolyte imbalances and hypotension. Exploratory laparotomy in the operation theatre was required for sealing the chyle leak after failure of medical and nutritional management in the intensive care unit. The main take-away message is that refractory chyle leak can occur in retroperitoneal surgeries requiring multidisciplinary management. Careful coordinated action between critical care, oncological, anesthesia and surgical teams is mandatory for a favourable outcome. Familiarity with the nuances of robotic surgery and eternal vigilance are the keys to successful conduction of complex robotic procedures.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 73-76

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MANAGEMENT OF CHYLE LEAK AFTER RETROPERITONEAL SURGERIES: CAN COLLAGEN SEALANT PATCH BE AN OPTION? - A CASE REPORT.

10.36106/0109971 ◽

2021 ◽

pp. 31-33

Author(s):

Mahendra Pal ◽

Gagan Prakash ◽

Ganesh K Bakshi

Keyword(s):

Case Report ◽

Lymph Node ◽

Local Recurrence ◽

Management Strategy ◽

Retroperitoneal Lymph Node Dissection ◽

Psychological Consequences ◽

Node Dissection ◽

Retroperitoneal Lymph Node ◽

Chyle Leak ◽

Surgical Interventions

Background: Chyle leak (CL) after retroperitoneal surgeries (RPS) is an uncommon and unwelcomed complication. Usually, it results due to the injury of major lymphatics during lymphadenectomy. CL is associated with adverse physical and psychological consequences and its management strategy also should focused on the patient's nutrition and psychological support. Conservative treatment (CT) is the initial treatment with good outcome, however selected patients require surgical interventions when CL does not stop with CT. Case report: 23 years old female who underwent radical nephrectomy with retroperitoneal lymph node dissection (RPLND) for local recurrence after initial partial nephrectomy, developed CL, which was refractory to conservative management. After futile available conservative options, patient was explored and CL nally stopped after suturing a collagen sealant patch (CSP) on the friable leak site. Conclusion: Collagen sealant patch is an effective alternative in surgical armament to control CL in unfavorable circumstances.

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