Mechanical pleurodesis aided by peritoneal drainage: procedure for hepatic hydrothorax.
BACKGROUND
Hepatic hydrothorax in the setting of decompensated cirrhosis is a challenging and common clinical problem. Traditional therapies such as diuretics and transjugular intrahepatic portosystemic shunts can be effective therapies in selected patients but in patients ineligible for, or intolerant of, these traditional therapies, few effective therapeutic options remain for the management of hepatic hydrothorax.


METHODS
We present a series of 5 consecutive patients with refractory hepatic hydrothorax who underwent combined thorascopically guided mechanical and chemical pleurodesis aided by an intraperitoneal drain that prevented reaccumulation of the ascites while pleural inflammation and adhesion were progressing. We speculate that the prolonged contact between the parietal and visceral pleura allowed by prevention of reaccumulation of intraabdominal ascites and subsequent flux through the pleural space enhanced the efficacy of this procedure in comparison with those presented in the literature.


RESULTS
Despite the fact that all of our patients presented with decompensated cirrhosis, the surgical procedure and subsequent hospitalization were tolerated well by our entire cohort. Colonization of the pleural and peritoneal drainage fluid was a common complication of this procedure but was not associated with prolonged morbidity or mortality.


CONCLUSIONS
We present a therapy for the difficult clinical problem of refractory hepatic hydrothorax that may allow selected patients an opportunity for prolonged symptomatic control.
Northup
Patrick G
PG
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia 22908, USA. pgn5qs@hscmail.mcc.virginia.edu
Harmon
R Christopher
RC
Pruett
Timothy L
TL
Schenk
Worthington G
WG
Daniel
Thomas M
TM
Berg
Carl L
CL
D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006876:Hydrothorax / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis / Q000379:methods*; D011788:Quality of Life; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome