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Clinical Investigations: TECHNIQUES |

Thoracoscopy and Talc Poudrage in the Management of Hepatic Hydrothorax*

Jose Ribas Milanez de Campos, MD; Laert Oliveira Andrade Filho, MD; Eduardo de Campos Werebe, MD; Hoel Sette Jr., MD; Angelo Fernandez, MD; Luiz Tarcísio Brito Filomeno, MD; Fabio Biscegli Jatene, MD
Author and Funding Information

*Divisions of Thoracic Surgery (Drs. de Campos, Filho, Andrade, Werebe, Fernandez, Filomeno, and Jatene) and Hepatology (Dr. Sette), Hospital Israelita Albert Einstein and Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to: Jose Ribas Milanez de Campos, MD, Thoracic Division, University of São Paulo, Rua Almirante Soares Dutra n. 520, São Paulo, Brazil 05654.000; e-mail: jribas@usp.br



Chest. 2000;118(1):13-17. doi:10.1378/chest.118.1.13
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Study objective: To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients.

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.


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