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pleurodesis

A procedure to create the symphysis between the parietal and visceral pleura in order to eliminate the pleural space so that fluid or air no longer builds up there. It can be used as the palliative treatment for malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax to alleviate symptoms (dyspnea, pain, and cough), avoid recurrence, and improve quality of life. Usage in benign effusion is highly controversial. Its principal indications are hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment. Plasma determinations of systemic inflammatory markers and thoracic ultrasound studies can evaluate the efficacy. Usage of non-steroidal anti-inflammatory drugs in the postoperative period is not recommended to avoid the possibility of interfering with hemostasis or the formation of adherences. (Types) • Chemical pleurodesis: Intrapleural administration of agents or chemical irritants that induce formation of pleural adhesions. Examples include talc (hydrous magnesium silicate, Mg3Si4O10(OH)2) (most common), bleomycin, tetracycline, iodopovidone, and Corynebacterium parvum. • Surgical pleurodesis: Video-assisted thoracoscopic surgery (VATS), direct injury to the pleura with mechanical or physical methods (e.g. mechanical abrasion, laser or argon beam coagulation) by videothoracoscopy. It is indicated primarily in the treatment of spontaneous pneumothorax because it is highly efficient, easy to carry out, and has low morbidity when compared to pleurectomy.