Abstract

Objective: Chemical pleurodesis in an effective treatment for malignant effusion and pneumothorax. Although this mode of therapy is less widely accepted in the treatment of patients with hepatic hydrothorax, the need for palliative treatment in such patients encouraged us to analyze the outcome of chemical pleurodesis using bovoiodine, vibramycin and talc slurry in the treatment of hepatic hydrothorax.

Material and Method: A prospective study including 23 patients with symptomatic right side hepatic hydrothorax not responding to medical treatment and repeated thoracocenthesis was carried out. From March 2007 through March 2008, 19 men and 4 women with a mean age of 54.3 ± 8.1 years (range 42-70 years) underwent medical thosacoscopies to achieve pleurodesis by application of 3 sclerosing agents.

Results: Of the 23 patients pleurodesis was repeated in 20 cases. Three cases were lost during the 3 months follow up period of the study. The procedure was effective in 15 of 20 patients (75%), 7/8 cases treated by bovoiodine (87.5%), 4/6 cases with vibramycin and talc slurry (66.7%) for each. There were 4 recurrences (20%) and a single case of mortality (5%) due to hepatic coma attributable to the course of the disease. We detected minimal morbidity during the follow up period of 3 months.

Conclusion: The procedure appears to be indicated for these fragile patients especially when medical therapy fails. Since efficacy was 75%, chemical pleurodesis deserves to be considered as an alterative therapy in such patients.