Management of chylous ascites after retroperitoneal lymph node dissection for testicular cancer

Iatrogenic ascites is an uncommon complication of surgery of the retroperitoneum, the base of the mesentery or mediastinum. We treated 18 patients with chylous ascites occurring after retroperitoneal dissection for testicular cancer. Patients were diagnosed by paracentesis or on clinical grounds (increasing abdominal girth). Of interest, 6 patients underwent resection of the inferior vena cava as part of the procedure, and this appears to be a high risk group for this complication. Management options include dietary restriction of fat, administration of medium chain triglycerides and diuretics, hyperalimentation, peritoneovenous shunt or surgery. The majority of patients were managed successfully by dietary treatment.