Study objective: To determine indications, limitations,
morbidity and mortality of surgical thoracoscopy for management of
hepatic hydrothorax, a rare, but often recurrent, complication in
Patients and 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).
Conclusion: 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.