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Thoracoscopy and talc poudrage in the management of hepatic hydrothorax
J R Milanez de Campos1, L O Filho, E de Campos Werebe
1Division of Thoracic Surgery, Hospital Israelita Albert Einstein and Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil. jribas@usp.br
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.