Chylous leak following laparoscopic distal gastrectomy with D2 dissection for a locally advanced, distal obstructive gastric cancer.

The lymphatic system was first described by Asel-lius in 1627, and chylous leak (CL) was first reported by Morton in 1691 [1, 2]. It is defined as the leakage of milk-like, triglyceride-rich lymphatic fluid from the lymphatic system in to the peritoneal cavity [3]. It can cause fever, abdominal pain, abdominal distension, and abnormal white blood cell count and a delay in the withdrawal of the abdominal drainage tube. Even more serious, improper treatment will lead to celiac infection and abdominal bleeding, which results in prolonged hospitalization and increased costs. The incidence of CL after gastrectomy with D1–2 dissection is reported as 1.99%; however, D3–4 lymphadenectomy is associated with a higher incidence of CL of up to 6.3% [4], indicating that locally advanced diseases and extensive lymph node dissection lead to a higher incidence of CL