Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases.
BACKGROUND
Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present.


METHODS
Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery (VATS). Repair of the diaphragmatic defects, or pleurodesis by focal pleurectomy, talc spray, mechanical abrasion, electro-cauterization or injection was administered intraoperatively, and tetracycline intrapleural injection was used postoperatively for patients with prolonged (>7 d) high-output (>300 ml/d) pleural effusion.


RESULTS
Out of the 12 patients, 8 (67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4 (33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites.


CONCLUSIONS
We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.
Luh
Shi-Ping
SP
Department of Thoracic Surgery, St Martin De Porres Hospital, Chia-Yi 60069, Taiwan, China. luh572001@yahoo.com.tw
Chen
Chi-Yi
CY
D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000473:pathology* / Q000601:surgery*; D008107:Liver Diseases / Q000473:pathology* / Q000601:surgery*; D008297:Male; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome