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Pleuroperitoneal shunting for recalcitrant pleural effusions
The Journal of Thoracic and Cardiovascular Surgery
|November 1, 1986
Summary
Pleuroperitoneal shunting effectively manages intractable malignant and benign effusions. This modified Denver shunt procedure provided relief without early complications and demonstrated long-term functionality in patients.
Area of Science:
- Thoracic Surgery
- Gastroenterology
- Oncology
Background:
- Intractable pleural effusions pose significant challenges in managing patients with malignant or benign conditions.
- Conventional therapies often fail to provide adequate relief for these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified double-valve Denver peritoneovenous shunt for treating intractable pleural effusions.
- To assess the functional outcomes and long-term complications associated with this shunting procedure.
Main Methods:
- Six patients with malignant (n=5) or benign (n=1) effusions underwent pleuroperitoneal shunting using a modified Denver shunt.
- The shunt was inserted under local anesthesia, connecting the pleural space to the subhepatic or pelvic area.
- Intraoperative pressures and shunt function were monitored; patients were instructed on active pumping (20 times, 4 times daily).
Main Results:
- No perioperative complications were observed.
- All shunts remained functional in surviving patients and functioned until death in those who expired.
- Active pumping effectively alleviated all pleural effusions, including bilateral cases.
- Two patients died within 1-2 months from unrelated causes, with their effusions relieved.
- Two patients survived at 10 and 20 months with no reported erosions, shunt failures, infections, or recurrent effusions.
Conclusions:
- Modified Denver pleuroperitoneal shunting is a safe and effective treatment for intractable pleural effusions.
- The procedure offers long-term functional benefit and symptom relief without significant complications.
- Active shunt management is crucial for maintaining patency and achieving optimal therapeutic outcomes.
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