SESSION TYPE: Thoracic Surgery Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: To describe the experience in the management of hepatic hydrothorax considering and comparing thoracoscopic and slurry pleurodesis.
METHODS: Retrospective review of medical charts of consecutive patients with diagnosis of hepatic hydrothorax.
RESULTS: 55 patients with hepatic hydrothorax diagnosis were found. 20 patients underwent surgical treatment and pleurodesis. There were 13 women. All patients were symptomatic and the principal symptom was dyspnea (100%). The pleural effusion was right sided in 75% of cases. Most patients had a pleural effusion greater than 50% (18 patients) and 9 patients had a massive effusion. According to fluid biochemical profile 80% were compatible with trasudate and 4 patients had an exudate and met the criteria for bacterial spontaneous empyema. Related to hepatic function 20% of patients had Child-Pugh A status; 10 patients (50%) B satus and 6 patients had Child-Pugh C status. There were two treatment groups. Gropup 1: chest tube and slurry talc/iodine pleurodesis; (8 patients) Group 2 thoracoscopy and talc poudrage (12 patients). The terapeutic response was as follows: 5 patients (25%) had a complete response; 7 patients (35%) parcial response and 5 patients had no response to treatment and persist with effusion and symptoms. In three cases no evaluation was possible due to mortality within 48 hrs in two patients and early transfer in one case. Morbidity was 40% (8 patients). No operatory mortality was present and the hospital mortality was 40% related to hepatic insufficiency.
CONCLUSIONS: Hepatic hydrothorax is a therapeutic challenge. However in 60% of cases a good response to treatment is present. The mortality is high but is not related to therapeutic procedures.
CLINICAL IMPLICATIONS: Surgical management of hepatic hydrothorax is possible by means of pleurodesis. Good response to treatment was found in our experience.
DISCLOSURE: The following authors have nothing to disclose: Juan Jacinto, Patricio Santillan-Doherty, Luis Argote-Greene, Rocio Carrera-Ceron, Julio Herrera-Zamora
No Product/Research Disclosure InformationAngeles de las Lomas Hospital, Huixquilucan Mex, Mexico