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Eur J Cardiothorac Surg 2007;31:1149. doi:10.1016/j.ejcts.2007.02.012
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Divisi et al.

Venanzio Porziellaa, Alfredo Cesarioa,b,*, Stefano Margaritoraa, Pierluigi Granonea

a Division of General Thoracic Surgery, Catholic University, Rome, Italy
b Department of Internal Medicine, IRCCS San Raffaele, Rome, Italy

Received 8 February 2007; accepted 12 February 2007.

* Corresponding author. Address: Division of General Thoracic Surgery, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy. Tel.: +39 0335 8366161; fax: +39 063 051162. (Email: alfcesario{at}yahoo.com).

Key Words: Chylothorax • Diagnosis • Video-assisted thoracic surgery (VATS)

We welcome the kind comments by Divisi and co-workers [1] regarding our opinion on the role of pre-operative lymphangiogram and lymphangioscintigraphy in the management of spontaneous chylothorax (SC) recently published in the Journal [2].

As a matter of fact we have addressed the diagnostic problems related to the SC which are more complex than those encountered in the management of the post-traumatic condition (PTC) as it is in discussion in [1], in fact in SC there is quite always an anatomical defect which is very likely to be its primary cause.

Regarding the intra-operative means to locate a lymph loss into the thorax we think that each surgeon could decide his/her action upon his/her personal experience. In our case we believe that the traditional fatty meal (milk and butter) is effective, still being cheap but of course, do not disregard any other option. Regarding the use of somatostatin analogues our point of view remains that if there is a leakage and this comes from an aberrant anatomy source (as it is often the case in SC) this approach can be really expensive with only partial advantages (and potential disadvantages in terms of delay of the surgical operation) in the overall treatment strategy which still sees surgery as its mainstay.

Our attitude to perform a pre-operative lymphangiography in SC is substantially supported by the fact that the knowledge of any aberrant lymphatic system anomaly could pilot the surgical intervention in order to obtain a definitive, single step, solution to the problem. Furthermore we believe that, in recurrent SC cases, a pre-operative lymphangiographic assessment can easily outline any additional leakage source that can be then correctly managed whereas the operative field may prove difficult to explore due to the first operation.

References

  1. Divisi D, Di Tommaso S, Crisci R. Preoperative red sudan administration to locate thoracic duct lesion in video-thoracoscopy. Eur J Cardiothorac Surg 2007;31:1148.[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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