From the Research
Enteral nutrition plus medium chain triglycerides is the preferred treatment option for patients with chylous ascites, as it is more cost-effective and has similar curative efficacy compared to total parenteral nutrition with bowel rest, as shown in a study published in 2016 1. The current evidence consists primarily of case reports, small case series, and expert opinions rather than randomized controlled trials.
- Both approaches are considered valid treatment options for chylous ascites.
- The first-line conservative approach typically involves a low-fat diet supplemented with MCTs, which can bypass intestinal lymphatic transport and be absorbed directly into the portal venous system, thereby reducing chyle production.
- This approach is generally preferred when feasible due to fewer complications compared to TPN.
- TPN with complete bowel rest is usually reserved for cases that fail to respond to dietary modification or in severe cases with high-volume chylous leakage.
- The duration of either treatment typically ranges from 2-6 weeks, with monitoring of ascites volume and triglyceride levels to assess response.
- Treatment success varies depending on the underlying cause of chylous ascites, with traumatic or postoperative causes generally responding better to conservative management than malignancy-related cases.
- The decision between these approaches should be individualized based on the severity of the condition, the patient's nutritional status, and the underlying etiology of the chylous ascites, as supported by studies such as 2, 3, 4, and 5. However, the most recent and highest quality study 1 suggests that enteral nutrition plus MCT is the best nutrition support in the conservative treatment of postoperative chylous ascites.