Thorac Cardiovasc Surg 2006; 54(1): 47-50
DOI: 10.1055/s-2005-865876
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Thoracoscopic Diaphragmatic Repair for Refractory Hepatic Hydrothorax: Application of Pleural Flap and Mesh Onlay Reinforcement

P.-M. Huang1 , S.-W. Kuo1 , J.-M. Lee1
  • 1Division of Thoracic Surgery, Department of Surgery and Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Further Information

Publication History

Received May 3, 2005

Publication Date:
17 February 2006 (online)

Abstract

Background: Management of hepatic hydrothorax is difficult, and no radical treatment has been established. Based on accumulating evidence that diaphragmatic defects contribute to hepatic hydrothorax, we developed a diaphragmatic repair method for the management of this complex condition. Methods: From October 2003 to March 2005, 10 patients (age, 32 - 83 years; 6 men and 4 women) with refractory hepatic hydrothorax (Child-Pugh class B - C) underwent thoracoscopic pleura (n = 7) or mesh (n = 3) onlay reinforcement to repair the diaphragmatic defects on which this study focuses, and all patients have since been under follow-up in a prospective observation study. Results: After a mean of 7.7 months of follow-up examinations, no local recurrence occurred in all patients. Two patients died of hemorrhage from esophageal varices two months postoperatively. All patients had a better postoperative pulmonary function. Conclusion: The use of pleura and mesh onlay reinforcement of the diaphragm is an encouraging treatment for refractory hepatic hydrothorax.

References

  • 1 Lazaridis K N, Frank J W, Krowka M J, Kamath P S. Hepatic hydrothorax: pathogenesis, diagnosis, and management.  Am J Med. 1999;  107 262-267
  • 2 Hidajat N, Vogl T, Stobbe H, Schmidt J, Wex C, Lenzen R, Berg T, Neuhaus P, Felix R. Transjugular intrahepatic portosystemic shunt: experiences at a liver transplantation center.  Acta Radiol. 2000;  41 474-478
  • 3 Temes R T, Davis M S, Follis F M, Pett J, Wernly J A. Videothoracoscopic treatment of hepatic hydrothorax.  Ann Thorac Surg. 1997;  64 1468-1469
  • 4 Huang P M, Chang Y L, Yang C Y, Lee Y C. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding.  J Thorac Cardiov S. 2005;  130 141-145
  • 5 Liberman F L, Peter R L. Cirrhotic hydrothorax. Further evidence that an acquired diaphragmatic defect is at fault.  Arch Intern Med. 1970;  125 144-147
  • 6 Kakizaki S, Katakai K, Yoshinaga T, Higuchi T, Takayama H, Takagi H, Nagamine T, Mori M. Hepatic hydrothorax in the absence of ascites.  Liver. 1998;  18 216-220
  • 7 Runyon B A, Greenblatt M, Ming R HC. Hepatic hydrothorax is a relative contraindication to chest tube insertion.  Am J Gastorenterol. 1986;  81 566-567
  • 8 Ikard R W, Sawyers J L. Persistent hepatic hydrothorax after peritoneojugular shunt.  Arch Surg-Chicago. 1980;  115 1125-1127
  • 9 Assouad J, Barthes F LEP, Shaker W, Souilamas R, Riquet M. Recurrent pleural effusion complicating liver cirrhosis.  Ann Thorac Surg. 2003;  75 986-989
  • 10 Ferrante D, Arguedas M R, Cerfolio R J, Collins B G, Leeuwen v D J. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax.  Am J Gastroenterol. 2002;  97 3172-3175
  • 11 Montanari M, Orsi P, Pugliano G. Hepatic hydrothorax without diaphragmatic defect: an original surgical treatment.  J Cardiovasc Surg. 1996;  37 425-427
  • 12 Xiol X, Guardiola J. Hepatic hydrothorax.  Curr Opin Pulm Med. 1998;  4 239-242
  • 13 Takayama T, Kurokawa Y, Kaiwa Y, Ansai M, Chiba T, Inoue T, Nakui M, Satomi S. A new technique of thoracoscopic pleurodesis for refractory hepatic hydrothorax.  Surg Endosc. 2004;  18 140-143
  • 14 Miscall L, Duffy R W. Surgical treatment of bullous emphysema.  Dis Ches. 1953;  24 489-499
  • 15 Lichtenstein I L. Hernia Repair Without Disability. 2nd ed. St. Louis; Ishiyaku EuroAmerica. Inc. 1986
  • 16 Steele S R, Lee P, Martin M J, Mullenix P S, Sullivan E S. Is parastomal hernia repair with polypropylene mesh safe?.  Am J Surg. 2003;  185 436-440
  • 17 Mannucci P M. Hemostatic drugs.  NEJM. 1998;  339 245-253

Dr. Pei-Ming Huang

Division of Thoracic Surgery
Department of Surgery and Traumatology
National Taiwan University Hospital

No. 7, Chung-Shan S. Rd

Taipei 100

Taiwan

Phone: + 886223562557

Fax: + 88 62 23 22 28 90

Email: e370089@ha.mc.ntu.edu.tw