Abstract
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.
Conclusion
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.
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References
Alberts, W.M., Salem, A.J., Solomon, D.A., Boyce, G., 1991. Hepatic hydrothorax. Cause and management. Arch. Intern. Med., 151(12):2383–2388. [doi:10.1001/archinte. 151.12.2383]
Bozkurt, S., Stein, J., Teuber, G., 2005. Hepatic hydrothorax. Z. Gastroenterol., 43(12):1319–1328. [doi:10.1055/s-2005-858742]
Cárdenas, A., Arroyo, V., 2007. Management of ascites and hepatic hydrothorax. Best Pract. Res. Clin. Gastroenterol., 21(1):55–75. [doi:10.1016/j.bpg.2006.07.012]
Cárdenas, A., Kelleher, T., Chopra, S., 2004. Review article: hepatic hydrothorax. Aliment. Pharmacol. Ther., 20(3): 271–279. [doi:10.1111/j.1365-2036.2004.02081.x]
Cerfolio, R.J., Bryant, A.S., 2006. Efficacy of video-assisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann. Thorac. Surg., 82(2):457–459. [doi:10. 1016/j.athoracsur.2006.03.057]
Chen, Y.J., Luh, S.P., Hsu, K.Y., Chen, C.R., Tsao, T.C., Chen, J.Y., 2008. Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax. J. Zhejiang Univ. Sci. B, 9(4):335–340. [doi:10.1631/jzus. B0720235]
Ferrante, D., Arguedas, M.R., Cerfolio, R.G., Collins, B.G., van Leeuwen, D.J., 2002. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Am. J. Gastroenterol., 97(12):3172–3175. [doi:10.1111/j.1572-0241.2002.07126.x]
Hsu, K.Y., Lee, H.C., Ou, C.C., Luh, S.P., 2009. Value of video assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma: 53 cases analysis and review of literature. J. Zhejiang Univ. Sci. B, 10(5): 375–379. [doi:10.1631/jzus.B0820368]
Huang, P.M., Chang, Y.L., Yang, C.Y., Lee, Y.C., 2005. The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic findings. J. Thorac. Cardiovasc. Surg., 130(1):141–145. [doi:10.1016/j.jtcvs.2004.08.051]
Ibi, T., Koizumi, K., Hirata, T., Mikami, I., Hisayoshi, T., Shimizu, K., 2008. Diaphragmatic repair of two cases of hepatic hydrothorax using video-assisted thoracoscopic surgery. Gen. Thorac. Cardiovasc. Surg., 56(5):229–232. [doi:10.1007/s11748-007-0221-8]
Kinasewitz, G.T., Keddissi, J.I., 2003. Hepatic hydrothorax. Curr. Opin. Pulm. Med., 9(4):261–265. [doi:10.1097/00063198-200307000-00003]
Lazaridis, K.N., Frank, J.W., Krowka, M.J., Kamath, P.S., 1999. Hepatic hydrothorax: pathogenesis, diagnosis, and man agement. Am. J. Med., 107(3):262–267. [doi:10. 1016/S0002-9343(99)00217-X]
Luh, S.P., Liu, H.P., 2006. Video-assisted thoracic surgery—the past, present status and the future. J. Zhejiang Univ. Sci. B, 7(2):118–128. [doi:10.1631/jzus.2006.B0118]
Luh, S.P., Wu, T.C., Wang, Y.T., Tsao, T.C., Chen, J.Y., 2007. Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis. J. Zhejiang Univ. Sci. B, 8(6):410–415. [doi:10.1631/jzus.2007.B0410]
Malinchoc, M., Kamath, P.S., Gordon, F.D., Peine, C.J., Rank, J., Terborg, P.C., 2000. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 31(4):864–871. [doi:10. 1053/he.2000.5852]
Milanez de Campos, J.R., Filho, L.O., de Campos Werebe, E., Sette, H.Jr., Fernandez, A., Filomeno, L.T., Jatene, F.B., 2000. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest, 118(1):13–17. [doi:10.1378/chest.118.1.13]
Mouroux, J., Perrin, C., Venissac, N., Blaive, B., Richelme, H., 1996. Management of pleural effusion of cirrhotic origin. Chest, 109(4):1093–1096. [doi:10.1378/chest.109.4.1093]
Roussos, A., Philippou, N., Mantzaris, G.J., Gourgouliannis, K.I., 2007. Hepatic hydrothorax: pathophysiology diagnosis and management. J. Gastroenterol. Hepatol., 22(9): 1388–1393. [doi:10.1111/j.1440-1746.2007.05069.x]
Strauss, R.M., Boyer, T.D., 1997. Hepatic hydrothorax. Semin. Liver Dis., 17(3):227–232. [doi:10.1055/s-2007-1007200]
Strauss, R.M., Martin, L.G., Kaufman, S.L., Boyer, T.D., 1994. Transjugular intrahepatic portal systemic shunt for the management of symptomatic cirrhotic hydrothorax. Am. J. Gastroenterol., 89:1520–1522.
Xiol, X., Casteliví, J.M., Guardiola, J., Sesé, E., Castellote, J., Perelló, A., Cervantes, X., Iborra, M.J., 1996. Spontaneous bacterial empyema in cirrhotic patients: a prospective study. Hepatology, 23(4):719–723. [doi:10.1002/hep.510 230410]
Zocchi, R., 2002. The physiology and pathophysiology of pleural fluid turnover. Eur. Respir. J., 20(6):1545–1558. [doi:10.1183/09031936.02.00062102]
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Luh, Sp., Chen, Cy. Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases. J. Zhejiang Univ. Sci. B 10, 547–551 (2009). https://doi.org/10.1631/jzus.B0820374
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DOI: https://doi.org/10.1631/jzus.B0820374