title: Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax.
abstract: BACKGROUND
  Patients with recurrent, refractory hepatic hydrothorax from porous diaphragm syndrome represent a therapeutic challenge with few options.
  
  
  METHODS
  A retrospective review of an electronic prospective database of patients with cirrhosis and refractory hepatic hydrothorax. Patients underwent video-assisted thoracoscopic surgery (VATS) with talc pleurodesis insufflating 2.5 g of talc. Successful therapy was defined as relief of dyspnea and control of symptomatic hydrothorax for a minimum of 6 months after the procedure.
  
  
  RESULTS
  There were 41 patients (21 men, median age 55 years), 25 with Child-Pugh class C and 14 with class B, and 2 liver transplant patients. The etiology of the cirrhosis was hepatitis B in 4, hepatitis C in 20, alcohol in 4, cryptogenic cirrhosis in 11, and other in 2. Definitive openings in the diaphragm were seen in only 2 patients. Seven patients (17%) required bedside talc slurry through the chest tube after the intraoperative talc. Overall success was achieved in 80% (33 of 41). Four patients experienced symptomatic fluid reaccumulation at 45, 61, 62, and 102 days and were treated with a repeat VATS, with success in 2. There was 1 operative death (coagulopathy).
  
  
  CONCLUSIONS
  Patients with recurrent effusions from porous diaphragm syndrome have few options. Video-assisted thoracoscopic surgery with talc is safe and successful in about three fourths of patients, but repeat talc slurry through the chest tube or repeat VATS is often needed. Video-assisted thoracoscopic surgery provides an effective alternative to transjugular intrahepatic portosystemic shunt and is a bridge toward liver transplantation in patients with few other options.
authors.affiliation: Division of Cardio-Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. rcerfolio@uab.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000628:therapy*; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000628:therapy*; D018700:Pleurodesis; D012008:Recurrence; D012189:Retrospective Studies; D013577:Syndrome; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
chemical_list: D013627:Talc