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Recurrent pleural effusion complicating liver cirrhosis
Jalal Assouad1, Françoise Le Pimpec Barthes, Walid Shaker
1Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France.
The Annals of Thoracic Surgery
|March 21, 2003
Summary
Pleural effusion in advanced liver cirrhosis is often caused by ascites leaking through diaphragmatic defects. Talc pleurodesis, especially via video-assisted thoracoscopy, offers effective surgical management for this rare complication.
Area of Science:
- Hepatology
- Thoracic Surgery
- Pulmonology
Background:
- Pleural effusion (PE) is a rare but serious complication of advanced liver cirrhosis.
- Uncontrolled PE may necessitate surgical intervention.
Purpose of the Study:
- To investigate the causes and occurrence of PE in liver cirrhosis patients.
- To evaluate the effectiveness of surgical management for PE in this population.
Main Methods:
- A study of 21 patients with massive, recurrent PE due to liver cirrhosis.
- Talc pleurodesis was attempted in all patients.
- Two groups: video-assisted thoracoscopy (VAT) pleurodesis (Group 1) and chest tube drainage with talc pleurodesis (Group 2).
Main Results:
- VAT pleurodesis (Group 1) resulted in a cure rate of 10/13 patients.
- Chest tube drainage (Group 2) had a higher complication rate, including septic shock and recurrence.
- Diaphragmatic defects were identified as a cause in some patients.
Conclusions:
- Ascites passage through diaphragmatic defects is a primary cause of PE in cirrhosis.
- Talc pleurodesis is beneficial, with VAT pleurodesis being the preferred technique.
- Repeated talc injections are a viable option for patients with poor clinical status.