Management of chylous ascites following laparoscopic presacral neurectomy

Chylous ascites is an extremely rare complication of laparoscopic presacralneurectomy (LPSN), and treatment is still controversial. Four patientsundergoing LPSN for dysmenorrhoea or chronic pelvic pain were complicatedwith chylous ascites. Two were successfully treated with bipolarcauterization and one, after the failure of initial treatment by bipolarcauterization, was then effectively managed by compression with Gelform andclosure of the peritoneum of the presacral area by suture throughlaparoscopy. The fourth patient had persistent chyle leakage from thedrainage tube after electrocauterization and was finally cured byconservative management including removal of the drainage tube and alow-fat diet for 3 weeks. Chylous ascites has not been reported inlaparoscopic presacral neurectomy. Management that is quick, effective andsubjects the patients to the least amount of suffering is still unresolved.Repeated laparoscopy can be considered to identify the possibility ofinjury to lymphatic vessels, to relieve abdominal distention due to chyleaccumulation, and to apply electrocauterization or compression with Gelformand closure of the peritoneum. Conservative treatment with a low-fat dietmay need a longer time. The use of a drainage tube may provide negativepressure allowing a continuous leakage of chyle. However, more controlledstudy is required to identify the most proper and effective management.