Mechanical Pleurodesis Aided by Peritoneal Drainage: Procedure for Hepatic Hydrothorax

Patrick G. Northup, R. Christopher Harmon, Timothy L. Pruett, Worthington G. Schenk, Thomas M. Daniel, Carl L. Berg

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)245-250
Number of pages6
JournalAnnals of Thoracic Surgery
Volume87
Issue number1
DOIs
StatePublished - Jan 2009

Bibliographical note

Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.

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