Octreotide in the treatment of thoracic duct injuries

Anecdotal reports support the use of octreotide in the treatment of traumat ic thoracic duct injuries and chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of octreotide in treating tho racic 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. Th rough a left supraclavicular neck incision, the thoracic duct was identifie d and transected, producing free flow of chyle. A quarter-inch drain was tu nneled subcutaneously from the wound and attached to closed suction. After wound closure dogs were randomized to a control group (n = 4) receiving sha m injections of saline subcutaneously three times per day, or a treatment g roup (n = 4) given 3 mug/kg octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output w as measured each day, and on odd-numbered postoperative days the drainage w as analyzed for cholesterol, triglycerides, albumin, and total protein. Fis tula closure was defined as drainage <10 ml/24-hour period. Treated dogs ac hieved fistula closure significantly faster than controls: 3.5 +/- 1.3 days versus 7.8 +/- 1.0 days (P = 0.0037). Whereas equivalent amounts of draina ge occurred on the day of surgery and on postoperative day one in both grou ps, by postoperative day 2 the treatment group had significantly less drain age over 24 hours: 63 +/- 69 mi versus 195 +/- 79 mi (P = 0.046); this sign ificant difference persisted through postoperative day 5 when drainage bega n to decrease in the control group. No significant differences between grou ps were seen in levels of cholesterol, triglycerides, albumin, or protein i n 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 clar ified.