Hepatic hydrothorax is defined as a pleural effusion that arises in patients with cirrhosis of the liver with no cardiopulmonary disease. A reasonable estimate is that it ranges from 5 to 6 % of liver cirrhosis, and even up to 10% with advanced disease. In most cases (85%) hepatic hydrothorax develops on the right side with 13% of cases occurring on the left side and 2% being bilateral, and even in absence of ascites.Chemical pleurodesis is often employed to treat recurrent pleural effusions, most often secondary to malignancies, and to prevent recurrent spontaneous pneumothorax. The goal of chemical pleurodesis is to form a symphysis between the parietal and visceral pleura, obliterating the pleural space and preventing fluid re-accumulation.This study was conducted on 23 patients with symptomatic right side hepatic hydrothorax not responding to medical treatment and repeated thoracentesis. All the patients received complete liver support several days before pleurodesis in addition to octreotide on the day before thoracoscopy. The patients were subjected to medical thoracoscopy under local anesthesia when the inclusion criteria were fulfilled. The accumulated pleural effusion was removed regardless its amount and intercostal tube was inserted followed immediately by instillation of the sclerosing material through it. The outcome of the present work revealed that pleurodesis was successful (No recurrence at 3 months follow up) in the management of hepatic hydrothorax in 15/19 (71%) patients, they were 4/6 cases treated by doxycycline 4/5 cases with talc slurry and 7/8 cases treated by iodopovidone.Medical thoracoscopy and pleurodesis represent an effective and safe treatment option for refractory hepatic hydrothorax provided that the patients were properly selected and aggressive supportive treatment was maintained. There was no difference between the three sclerosing materials used.