Thoracoscopic diaphragmatic repair for refractory hepatic hydrothorax: application of pleural flap and mesh onlay reinforcement.
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.


CONCLUSIONS
The use of pleura and mesh onlay reinforcement of the diaphragm is an encouraging treatment for refractory hepatic hydrothorax.
Division of Thoracic Surgery, Department of Surgery and Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. e370089@ha.mc.ntu.edu.tw
P-M
PM
Huang
S-W
SW
Kuo
J-M
JM
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006876:Hydrothorax / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh; D016019:Survival Analysis; D013906:Thoracoscopy / Q000009:adverse effects; D016896:Treatment Outcome