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109 Laparoscopic treatment of refractory chylous ascites after endometrial cancer surgical staging
  1. R Ribeiro1,2,
  2. A Estremadoiro Vargas1,
  3. JC Linhares1,2,
  4. G Rengel dos Santos3 and
  5. A Tsunoda1,2
  1. 1Hospital Erasto Gaertner, ginecologia oncologica, curitiba, Brazil
  2. 2Instituto de Oncologia do Paraná, Ginecologia Oncologica, Curitiba, Brazil
  3. 3Hospital Erasto Gaertner, Radiologia, Curitiba, Brazil


Objectives Chylous ascites is a rare condition following gynecologic surgery, with an eminent clinical management. Refractory cases with persistent symptoms may occur.

Objective The main objective of this video is to demonstrate an alternative treatment for chylous ascites after lymphadenectomy in patients who did not respond adequately to a conservative clinical approach.

Methods In this case-report, a 52-year-old patient with a uterine Stage II G2 endometrioid adenocarcinoma underwent complete laparoscopic surgical staging. The initial procedure included a type B total hysterectomy with bilateral salpingooforectomy, with pelvic and para-aortic lymphadenectomy. Final report included 30 para-aortic and 22 pelvic lymph nodes, all free of disease.

Patient evolved with increased abdominal volume and discomfort on the 15th postoperative day, diagnostic/therapeutic paracentesis was performed, with a diagnosis of chylous ascites.

A conservative clinical management failed to control the symptoms. An alternative surgical treatment was offered with laparoscopic exploration.

Results This video demonstrates the surgical findings and the surgical technique. The patient received a high fat solution 6 hours before surgery. After draining all chylous ascites, the main lymphatic ducts at the level of left renal vein, and right common iliac vein were identified, cliped and suture ligated. There was an immediate resolution of the leakage, and the patient was discharged in the second postoperative day, without any complication. Outpatient follow-up was performed with control CT scans, with no evidence of new episodes of ascites.

Conclusions This laparoscopic approach was succesfull in a case of chylous ascites refractory to clinical management.

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