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Pleuro-peritoneal shunting. Alternative therapy for pleural effusions
A G Little1, M H Kadowaki, M K Ferguson
1Department of Surgery, University of Chicago, Illinois.
Annals of Surgery
|October 1, 1988
Summary
Pleuroperitoneal shunting offers an effective alternative for managing refractory pleural effusions, providing symptomatic relief and stabilization with minimal hospitalization. This procedure demonstrates excellent outcomes in carefully selected patients, particularly those with malignant effusions or trapped lung syndrome.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Medical Devices
Background:
- Pleural effusions often resist standard treatments, leading to patient discomfort and extended hospital stays.
- Alternative therapies are needed for effusions unresponsive to conventional interventions like thoracentesis or chest tubes.
Purpose of the Study:
- To evaluate the efficacy and safety of pleuroperitoneal shunting for various types of pleural effusions.
- To assess outcomes in patients with refractory effusions, including those with malignancy and trapped lung syndrome.
Main Methods:
- 36 pleuroperitoneal shunts were implanted in 29 patients with diverse pleural effusion etiologies.
- Patient history included prior treatments such as thoracentesis, chest tube placement, and sclerosis.
- Outcomes were assessed based on symptomatic relief, effusion status, and patient survival.
Main Results:
- No operative mortality was observed; 83.3% of patients achieved excellent results with symptomatic relief and effusion stabilization.
- Patients with chylothorax experienced complete resolution, while those with malignant effusions had a median survival of 4 months.
- Five patients had poor outcomes due to poor health or inability to manage the shunt; no peritoneal tumor seeding occurred.
Conclusions:
- Pleuroperitoneal shunting is a viable alternative for managing pleural effusions, requiring limited hospitalization and causing minimal discomfort.
- The procedure yields excellent results in appropriately selected patients and is crucial when lung expansion is not achievable.
- It offers a valuable therapeutic option for refractory effusions, including malignant and chylous types.