Anecdotal reports support the use of
octreotide in the treatment of traumatic thoracic duct
injuries and
chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of
octreotide in treating thoracic duct transection in a canine model. Eight mongrel dogs (27.8+/-5.1 kg) were fed one pint of 10.5 per cent milkfat 2 hours before operation. Through a left supraclavicular neck incision, the thoracic duct was identified and transected, producing free flow of chyle. A quarter-inch drain was tunneled subcutaneously from the
wound and attached to closed suction. After
wound closure dogs were randomized to a control group (n = 4) receiving
sham injections of saline subcutaneously three times per day, or a treatment group (n = 4) given 3 microg/kg
octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output was measured each day, and on odd-numbered postoperative days the drainage was analyzed for
cholesterol,
triglycerides,
albumin, and total
protein.
Fistula closure was defined as drainage <10 ml/24-hour period. Treated dogs achieved
fistula closure significantly faster than controls: 3.5+/-1.3 days versus 7.8+/-1.0 days (P = 0.0037). Whereas equivalent amounts of drainage occurred on the day of surgery and on postoperative day one in both groups, by postoperative day 2 the treatment group had significantly less drainage over 24 hours: 63+/-69 ml versus 195+/-79 ml (P = 0.046); this significant difference persisted through postoperative day 5 when drainage began to decrease in the control group. No significant differences between groups were seen in levels of
cholesterol,
triglycerides,
albumin, or
protein in the drainage at any time point. We conclude that
octreotide is effective in treating thoracic duct injury, leading to an early decrease in drainage and early
fistula closure. The mechanism for this effect remains to be clarified.