Definition and classification of chyle leak after pancreatic operation

A consensus statement by the International Study Group on Pancreatic Surgery

for the International Study Group on Pancreatic Surgery

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)365-372
Number of pages8
JournalSurgery (United States)
Volume161
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Chyle
Consensus
Chylous Ascites
Octreotide
Total Parenteral Nutrition
Intensive Care Units
Length of Stay
Triglycerides
Therapeutics
Communication
Maintenance
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Definition and classification of chyle leak after pancreatic operation : A consensus statement by the International Study Group on Pancreatic Surgery. / for the International Study Group on Pancreatic Surgery.

In: Surgery (United States), Vol. 161, No. 2, 01.02.2017, p. 365-372.

Research output: Contribution to journalArticle

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title = "Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery",
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.",
author = "{for the International Study Group on Pancreatic Surgery} and Besselink, {Marc G.} and {van Rijssen}, {L. Bengt} and Claudio Bassi and Christos Dervenis and Marco Montorsi and Mustapha Adham and Asbun, {Horacio J.} and Maximillian Bockhorn and Oliver Strobel and B{\"u}chler, {Markus W.} and Busch, {Olivier R.} and Charnley, {Richard M.} and Conlon, {Kevin C.} and Laureano Fern{\'a}ndez-Cruz and Abe Fingerhut and Helmut Friess and Izbicki, {Jakob R.} and Lillemoe, {Keith D.} and Neoptolemos, {John P.} and Sarr, {Michael G.} and Shrikhande, {Shailesh V.} and Robert Sitarz and Vollmer, {Charles M.} and Yeo, {Charles J.} and Werner Hartwig and Christopher Wolfgang and Gouma, {Dirk J.}",
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T1 - Definition and classification of chyle leak after pancreatic operation

T2 - A consensus statement by the International Study Group on Pancreatic Surgery

AU - for the International Study Group on Pancreatic Surgery

AU - Besselink, Marc G.

AU - van Rijssen, L. Bengt

AU - Bassi, Claudio

AU - Dervenis, Christos

AU - Montorsi, Marco

AU - Adham, Mustapha

AU - Asbun, Horacio J.

AU - Bockhorn, Maximillian

AU - Strobel, Oliver

AU - Büchler, Markus W.

AU - Busch, Olivier R.

AU - Charnley, Richard M.

AU - Conlon, Kevin C.

AU - Fernández-Cruz, Laureano

AU - Fingerhut, Abe

AU - Friess, Helmut

AU - Izbicki, Jakob R.

AU - Lillemoe, Keith D.

AU - Neoptolemos, John P.

AU - Sarr, Michael G.

AU - Shrikhande, Shailesh V.

AU - Sitarz, Robert

AU - Vollmer, Charles M.

AU - Yeo, Charles J.

AU - Hartwig, Werner

AU - Wolfgang, Christopher

AU - Gouma, Dirk J.

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N2 - 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.

AB - 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.

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