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Minimally invasive surgical strategy for refractory hepatic hydrothorax.
- Source :
-
European Journal of Cardio-Thoracic Surgery . May2020, Vol. 57 Issue 5, p881-887. 7p. - Publication Year :
- 2020
-
Abstract
- Open in new tab Download slide Open in new tab Download slide OBJECTIVES Treatment of refractory hepatic hydrothorax, a complication of liver cirrhosis, is complex. We aimed to investigate the usefulness of the '4-step approach', which is a minimally invasive surgical strategy combining 4 therapeutic modalities: (i) pneumoperitoneum to localize diaphragmatic defects; (ii) thoracoscopic pleurodesis; (iii) postoperative positive-pressure ventilation; and (iv) peritoneal drainage for abdominal decompression. METHODS We retrospectively analysed the medical records of 12 patients with hepatic hydrothorax who underwent surgical treatment using the 4-step approach from January 2013 to December 2017. Nine of them (75.0%) were Child C cases; the median model for end-stage liver disease score was 20.5. The diaphragmatic defects localized after forming a pneumoperitoneum were treated with primary closure followed by thoracoscopic pleurodesis, postoperative positive-pressure ventilation and peritoneal drainage. RESULTS Diaphragmatic defects were localized in all patients except one. The median postoperative positive-pressure ventilation duration was 20.1 h. Peritoneal drainage was performed for a median duration of 5 days; the peritoneal drains were removed at a median of 8 postoperative days. The median duration of postoperative hospital stay until discharge/transfer was 9.5 days. No operative mortalities occurred. The median duration of follow-up was 10.9 months. Eight deaths (66.7%) occurred during the follow-up period; however, no deaths were surgery-associated. Ipsilateral pleural effusion recurred in 3 patients (25%), among whom reoperation was performed in 1 without recurrence at the 13-month follow-up. CONCLUSIONS The 4-step approach seems to be a safe and effective minimally invasive surgical strategy for treating refractory hepatic hydrothorax. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10107940
- Volume :
- 57
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- European Journal of Cardio-Thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 143381669
- Full Text :
- https://doi.org/10.1093/ejcts/ezz342