title: Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery with talc pleurodesis is a therapeutic option for patients with hepatic hydrothorax that is refractory to medical therapy. We report the outcomes of 15 patients who underwent this procedure for significantly symptomatic disease.
  
  
  METHODS
  Data on 15 consecutive patients presenting to our institution between November, 1996, and June, 2000, with refractory hepatic hydrothorax was retrospectively collected. Baseline demographical and clinical characteristics and outcomes after the procedure were analyzed.
  
  
  RESULTS
  The mean age of our cohort was 51.5 yr, and eight (53%) of the 15 patients were male. The etiologies of liver disease were hepatitis C virus and/or alcohol (n = 12) and cryptogenic cirrhosis (n = 3). Nine patients were Child-Pugh class C and six class B. Success defined as control of symptomatic hydrothorax in the first 30 days after the procedure was achieved in 11 of 15 patients (73%). Eight of these patients remained asymptomatic at a median follow-up of 5.5 months after the procedure, but three patients experienced symptomatic fluid reaccumulation 45, 61, and 62 days after the initial procedure. After a second VATS procedure, control was achieved in two of these three patients. Complications included pain around the chest tube site, low grade fever with leukocytosis, pleurocutaneous fistula and empyema, all of which responded to medical therapy. Four patients did not respond to the procedure. There were no procedure-related deaths. Overall mortality and baseline clinical characteristics were similar between responders and nonresponders to VATS with pleurodesis.
  
  
  CONCLUSIONS
  Symptomatic hepatic hydrothorax can be controlled with a single VATS with pleurodesis in as many as 53% of patients and with two procedures in 73% with no procedure-related mortality. The procedure may be considered as a palliative alternative in patients needing frequent thoracocentesis. It also provides an alternative to transjugular intrahepatic portosystemic shunts and is a bridge toward liver transplantation.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-005, USA.
authors.forename: Dino
authors.initials: D
authors.lastname: Ferrante
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Arguedas
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Barry G
authors.initials: BG
authors.lastname: Collins
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Leeuwen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology* / Q000601:surgery*; D018700:Pleurodesis; D012086:Reoperation; D012189:Retrospective Studies; D013627:Talc / Q000627:therapeutic use*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D013627:Talc