Besselink et al defined criteria for a chyle leak after a pancreatic operation. The criteria have overlap with previous definitions, such as the one of van der Gaag et al. The authors are from the International Study Group on Pancreatic Surgery with authors from multiple hospitals in Europe and North America.
Patient selection: pancreatic surgery
Definition of chyle leak:
(1) output of a milky fluid on postoperative day 3
(2) from drain, drain site or wound
(3) fluid triglyceride concentration >= 1.2 mmol/L (>= 110 mg/dL)
The consequences are grade from Grade A to Grade C.
Grade A: without consequence (clinically irrelevant). No dietary changes, no readmission, no discharge with drain, and no prolongation of hospital stay.
Grades B and C may have readmission, may have discharge with drain, and/or have prolonged hospital stay.
(1) Grade B: first line interventions (any combination of: nasoenteral with dietary restriction or TPN nutrition; percutaneous drainage by interventional radiology; octreotide or other drug therapy; prolonged use of drains)
(2) Grade C: admission to ICU, death, other in-hospital invasive intervention
