Beyond Drainage: Octreotide for Persistent Chyle Leak Following Robotic Partial Nephrectomy

Chyle leak is a rare complication of renal surgery caused by disruption of retroperitoneal lymphatics and is infrequently reported following robotic partial nephrectomy.Unlike direct lymphatic ligation in open surgery or ultrasonic sealing commonly employed in laparoscopy, robotic dissection frequently relies on surgical decision-making, which may not provide definitive lymphatic sealing.We report the case of a 66year-old man who underwent left robotic partial nephrectomy for a renal tumour.His immediate postoperative course was uneventful, with only serosanguinous drain output, permitting discharge after drain removal on postoperative day (POD) 4.However, on routine follow-up imaging on POD 10, an approximately 200-mL perirenal collection was detected.On POD 11, ultrasound-guided pigtail drainage was performed, and biochemical analysis of the drained fluid confirmed a chyle leak.In view of persistent chylous drain output, a structured conservative strategy comprising continued percutaneous drainage, dietary fat restriction, and intramuscular octreotide was instituted.Following initiation of octreotide, there was a progressive reduction in chyle output with concomitant resolution of the perirenal collection.The leak ultimately resolved without the need for lymphangiographic intervention or surgical re-exploration.This report shows that persistent chyle leakage can be challenging to manage, highlighting the potential role of somatostatin analogues such as octreotide in facilitating conservative resolution.