Which surgical procedures are used in the treatment of pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Pleurodesis by insufflating talc directly onto the pleural surface using video-assisted thoracoscopy is an alternative to using talc slurries.

Decortication is usually required for trapped lungs to remove the thick, inelastic pleural peel that restricts ventilation and produces progressive or refractory dyspnea. In patients with chronic, organizing parapneumonic pleural effusions, technically demanding operations may be required to drain loculated pleural fluid and to obliterate the pleural space.

Surgically implanted pleuroperitoneal shunts are another treatment option for recurrent, symptomatic effusions, most often in the setting of malignancy, but they are also used for management of chylous effusions. However, the shunts are prone to malfunction over time, can require surgical revision and are poorly tolerated by patients.

In unusual cases, surgery might be required to close diaphragmatic defects (thereby preventing recurrent accumulation of pleural effusions in patients with ascites) and to ligate the thoracic duct to prevent reaccumulation of chylous effusions.

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