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

Huang, Pei-Ming; Kuo, Shuenn‐Wen; Lee, Jang-Ming

doi:10.1055/s-2005-865876

Cited by 23 publications

(13 citation statements)

References 9 publications

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“…Successful thoracoscopic pleura or Mersilene mesh reinforcement on the diaphragm in 10 cirrhotic patients with HH has been reported. 49 In conclusion, video-assisted thoracoscopy with concomitant talc pleurodesis for refractory hydrothorax is successful in 40 to 75% of patients but may result in prolonged hospitalization and pleural space drainage with severe secondary effects (hyponatremia, infection), and a considerable mortality. Patients with demonstrable diaphragmatic defects treated with closure have better results than those without demonstrable fenestrations.…”

Section: Diagnosismentioning

confidence: 94%

Pleural Effusion in Liver Disease

Alonso

2010

Semin Respir Crit Care Med

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Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Thoracentesis and pleural fluid analysis are necessary for diagnosis. Initial management consists of sodium restriction, diuretics, and therapeutic thoracentesis. A transjugular intrahepatic portosystemic shunt may provide a bridge prior to liver transplantation. Spontaneous bacterial empyema is the infection of a preexisting hydrothorax. The more frequent bacteria involved are ENTEROBACTERIACEAE and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.

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Section: Diagnosismentioning

confidence: 94%

Pleural Effusion in Liver Disease

Alonso

2010

Semin Respir Crit Care Med

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“…68 Moreover, the use of pleura and mesh onlay reinforcement of the diaphragm seems to be an encouraging treatment for refractory hepatic hydrothorax. 69 However, more studies in larger numbers of patients are needed to confirm these results.…”

Section: Surgical Interventionsmentioning

confidence: 96%

Hepatic hydrothorax: Pathophysiology diagnosis and management

Roussos

Philippou

Mantzaris

et al. 2007

J of Gastro and Hepatol

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Hepatic hydrothorax is defined as a significant pleural effusion (usually greater than 500 ml) in a cirrhotic patient, without an underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with a unilateral pleural effusion, most commonly right-sided. In the vast majority of cases, patients with hepatic hydrothorax have end-stage liver disease. Therefore, they should be considered potential candidates for orthotopic liver transplantation. Until the performance of transplantation, other therapeutic modalities should be applied in order to relieve symptoms and prevent pulmonary complications.

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“…Although video-assisted thoracoscopic surgery (VATS) for suturing diaphragmatic defects has been reported to be effective in reducing pleural effusion in patients with HH [13,14], residual or recurrent pleural effusion has been observed clinically. To resolve this problem, the use of thoracoscopic mesh onlay reinforcement to prevent ascites leaking from sutured holes in patients with refractory HH was introduced in our center 10 years ago [15]. Use of thoracoscopic mesh allows for a fibroblastic response through the interstices of the mesh and for progressive formation of a strong fibrous wall [15].…”

mentioning

confidence: 99%