Thoracoscopy and chemical pleurodesis in treatment of pancreatogenic pleural effusion

Objective. To determine the opportunities of thoracoscopy and the effectiveness of induction of chemical pleurodesis by intrapleural administration of drugs for pancreatogenic pleurisy.

Material and methods. We analyzed the results of surgical treatment of 17 patients with acute pancreatitis and 14 – with pancreatic cysts after necrosis complicated by pancreatogenic pleural effusions, accounting for 3,7 % of all effusions.

Results. Mild and moderate pleurisy was successfully suppressed in 4 cases (12.9 %) by pleural punctures. Six patients (19.4 %) with pancreatic necrosis and huge pleural effusion in case of severe conditions underwent pleural drainage. In 20 cases (64.5 %), fragmented pleurisy was treated using thoracoscopy. Pleurodesis was performed by means of insufflation of talcum powder in five cases that permitted to reduce the drainage time from 7.14 ± 2.96 days without pleurodesis to 4.2 ± 1.1 days (p = 0.026). Pleurodesis using application of trichloroacetic acid had no effect in three patients. Five patients received 200–300 μg of octreotide diluted with 40 ml of isotonic sodium chloride solution into the pleural cavity through the drainage. The drainage period reduced to 3.5 ± 1.0 days (p = 0.018). The effect was maximally expressed in the cases with high amylase level in the pleural exudate. After that, 20 patients underwent various operations on the pancreas.

Conclusions. Thoracoscopy is indicated to patients with pancreatogenic pleurisy for removal of fragments and sanation of the pleural cavity. Intraoperative pleurodesis with talcum effectively suppresses pleurisy and reduces the drainage period while application of trichloroacetic acid has no essential influence. Intrapleural administration of octreotide allows rapid reducing exudation when amylase index is high. Our study supports the effectiveness of mini-invasive procedures (videothoracoscopy combined with talcum powder pleurodesis and intrapleural administration of octreotide) to sanitize the pleural cavity, suppress pleurisy and shorten drainage periods.