Chest
Volume 118, Issue 1, July 2000, Pages 13-17
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Clinical Investigations: Techniques
Thoracoscopy and Talc Poudrage in the Management of Hepatic Hydrothorax

https://doi.org/10.1378/chest.118.1.13Get rights and content

Study objective

To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients.

Patients and methods

From May 1985 through May 1999, 10 men and 8 women, with a mean age of 57.6 years (range, 26 to 76 years), underwent 21 therapeutic thoracoscopies to achieve pleurodesis by application of talc.

Results

The procedure was effective in 10 of 21 procedures. There were four recurrences (19.1%) that were retreated, with only one being successful. In this specific group, we detected high morbidity (57.1%) and mortality (38.9%) during the follow-up period of 3 months. Diaphragmatic defects were localized and closed five times (23.8%). Hospital stay was approximately 15 days (range, 5 to 41 days).

Conclusion

The procedure appears to be indicated for these fragile patients, especially when medical therapy fails. Immediate efficacy was 47.6%, increasing to 60% with videothoracoscopy and suture of the diaphragmatic defect. However, morbidity and mortality were high.

Section snippets

Materials and Methods

A retrospective study is presented of 18 consecutive patients with clinical, laboratory, and radiologic evidence of liver disease, portal hypertension, and persistent right-sided symptomatic HH who were admitted to the Hospital Israelita Albert Einstein and Hospital das Clínicas, from May 1985 through May 1999. They underwent 21 procedures to control the pleural effusions. All patients had undergone multiple medical management and thoracenteses before transfer to our hospitals.

The series

Results

Thoracoscopy and talc insufflation were well tolerated by the patients in the present series (Table 1). Aerosolized talc was effective in the treatment of HH in 10 of 21 procedures (47.6%). Four recurrences (19.1%) occurred and were retreated. However, only one remained without recurrence during the next 3 months. The follow-up period was at least 3 months in all the surviving patients. During the study period, 7 of 18 patients (38.9%) died of hemorrhage secondary to esophageal varices (n = 2)

Discussion

Since the article in 1958 by Morrow et al11 describing HH as a rapid accumulation of massive right pleural effusion, after a diagnosis of cirrhosis of the liver, various studies have been published. Although a wealth of literature on the treatment of symptomatic HH exists, the optimal or standard therapy remains unclear. Once the diagnosis of HH is established, medical therapy with salt restriction and diuretics is initiated. The term refractory HH is used when these measures are ineffective.

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