Thoracoscopy and talc poudrage in the management of hepatic hydrothorax.
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.


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).


CONCLUSIONS
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.
Milanez de Campos
J R
JR
Division 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
Filho
L O
LO
de Campos Werebe
E
E
Sette
H
H
Fernandez
A
A
Filomeno
L T
LT
Jatene
F B
FB
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis; D012189:Retrospective Studies; D015996:Survival Rate; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome
D013627:Talc