Two Cases of Chylous Ascites after Robot-Assisted Laparoscopic Gastrectomy

Abstract

Case 1 was a 70-year-old woman who underwent robot-assisted proximal gastrectomy, D1 + lymph node dissection, and esophagogastrostomy for type 1 advanced gastric cancer of the upper anterior wall of the gastric corpus. The histopathological diagnosis was tub2, pT3, pN2, cM0, pStage IIIA. On the 6th day after surgery, open abdominal drainage was performed for anastomotic leakage at the gastro-esophagostomy. After the second operation, chylous ascites was discharged by the indwelling drain. Inguinal intranodal lymphangiography using lipiodol was performed, and the chylous ascites then decreased. Case 2 was a 40-year-old woman who underwent robot-assisted distal gastrectomy, D1 + lymph node dissection, and Roux-en-Y reconstruction for 0-IIc lesions of the lower anterior wall of the gastric corpus. The histopathological diagnosis showed por2, pT1b2, pN0, cM0, pStageIA. Open abdominal ligation of a lymphatic fistula was performed 44 days after the first operation because of intractable chylous ascites. After the operation, the amount of ascites decreased. Although there is no established treatment for chylous ascites after gastrectomy, it could start with conservative treatment, and if it is ineffective, lipiodol lymphangiography or surgery should be considered.