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.
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Authors | Robert J Cerfolio, Ayesha S Bryant |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 82
Issue 2
Pg. 457-9
(Aug 2006)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 16863743
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Combined Modality Therapy
- Female
- Humans
- Hydrothorax
(therapy)
- Liver Cirrhosis
(therapy)
- Male
- Middle Aged
- Pleural Effusion
(therapy)
- Pleurodesis
- Recurrence
- Retrospective Studies
- Syndrome
- Talc
(administration & dosage)
- Thoracic Surgery, Video-Assisted
(methods)
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