Pleuroperitoneal shunting for recalcitrant pleural effusions.

From March 1, 1984, to Nov. 1, 1985, six patients underwent pleuroperitoneal shunting for either malignant (n = 5) or benign (n = 1) effusions intractable to the usual therapy. A modified double-valve Denver peritoneovenous shunt was inserted under local anesthesia in each case, and fluid from the right or left pleural space was shunted to the subhepatic space or pelvic area. No early complication was recognized in the perioperative period. Each shunt is working in the patients who are alive, and both functioned up to the time of death in the two who have died. Intraoperative pressures simultaneously recorded from both the chest and abdomen indicated that spontaneous flow would not occur without active pumping. All pleural effusions, including the solitary bilateral one, were alleviated by pumping the shunt 20 times four times a day. Two of the patients with cancer died after 1 and 2 months of unrelated events, with their symptomatic pleural effusions relieved. Two are alive at 20 and 10 months, respectively. The long-term follow-up revealed no erosions, shunt failures, infections, or symptomatic pleural effusions.