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Eur J Cardiothorac Surg 2007;31:1148-1149. doi:10.1016/j.ejcts.2007.02.011
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Preoperative red sudan administration to locate thoracic duct lesion in videothoracoscopy

Duilio Divisi*, Sergio Di Tommaso, Roberto Crisci

Department of Thoracic Surgery, University of L’Aquila, "G. Mazzini" Hospital, Teramo, Italy

Received 13 January 2007; accepted 12 February 2007.

* Corresponding author. Address: Circonvallazione Ragusa 39, 64100 Teramo, Italy. Tel.: +39 0861 429481; fax: +39 0861 429478. (Email: duilio.divisi{at}aslteramo.it).

Key Words: Chylothorax • Video-assisted thoracic surgery • Red sudan • Octreotide • Somatostatin

The considerations of Christodoulou et al. [1] and Porziella et al. [2] concerning the ideal diagnostic and therapeutic approach to chylothorax raise an interesting debate. We would like to contribute with our experience to this discussion.

From October 2003 to November 2006 we observed 13 patients with chylothorax, 8 on the right and 5 on the left side: (a) 2 presented an iatrogenic origin (15%), due to an esophagectomy for carcinoma and a thymectomy for thymoma, treated by thoracotomy; (b) 11 were traumatic (85%), treated by pleural drainage and total parenteral nutrition for 7 days. This procedure had an excellent result in two patients (18%); the average time of hospitalization was 8 ± 1 day. In the other nine patients (82%) the use of 6 µg/kg/24 h of somatostatin by continuous endovenous infusion (four cases) or 100 µg/8 h of octreotide by subcutaneous injection (five cases) was carried out for a further 7 days. In three somatostatin (33%) and two octreotide (22%) patients recovery was obtained; thoracostomy tube was removed after 15 ± 1 day. In four patients (45%) the clinical patterns (dyspnea, fever, hypovolemia) associated to a persistent loss of chylo >200 ml/day, indicated the need for intervention. Method consisting in administration of 10 ml of red sudan by nasogastric tube and in supradiaphragmatic thoracic duct ligation 1 h later by video-assisted thoracoscopy (VATS), with a pleural poudrage (4 g of Luzenac spray talc). Pleural drainage was removed after 5 ± 1 day from intervention; the resolution rate was 100%.

In this letter we ask the authors their opinion on the use of somatostatin and octreotide in conservative treatment and of red sudan in surgical management. Somatostatin and octreotide reduce lymph secretion by a decrease in hepatic venous pressure and splanchnic blood flow. Red sudan allows direct intraoperative visualization of the lesion, making the surgical technique easier without applying preoperative lymphangiography or lymphangioscintigraphy. Moreover, we think that VATS is necessary only when conservative therapy fails.

Footnotes

\#9734; The authors of the original paper [1] were invited to reply to this Letter to the Editor but they did not respond.

References

  1. Christodoulou M, Ris H-B, Pezzetta E. Video-assisted right supradiaphragmatic thoracic duct ligation for non traumatic recurrent chylothorax. Eur J Cardiothorac Surg 2006;29:819-824.[Abstract/Free Full Text]
  2. Porziella V, Cesario A, Margaritora S, Granone P. Role of pre-operative lymphangiogram and lymphangioscintigraphy in the surgical management of spontaneous chylothorax. Eur J Cardiothorac Surg 2006;30:813.[Free Full Text]



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 Eur. J. Cardiothorac. Surg.Home page
V. Porziella, A. Cesario, S. Margaritora, and P. Granone
Reply to Divisi et al.
Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1149 - 1149.
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