Thoracoscopic Mesh Repair of Diaphragmatic Defects in Hepatic Hydrothorax: A 10-Year Experience
Journal
Annals of Thoracic Surgery
Journal Volume
101
Journal Issue
5
Pages
1921-1927
ISBN
26897323
Date Issued
2016
Abstract
Background The objective was to analyze the outcomes of thoracoscopic mesh repair for hepatic hydrothorax (HH) at our institution during the past 10 years. Methods A total of 63 patients with refractory HH who underwent thoracoscopic mesh onlay reinforcement to repair diaphragmatic defects from January 2005 to December 2014 were included in the study. Mesh covering alone was used in 47 patients and mesh with suturing was used in 16 patients. Patient demographics, Child-Pugh class, and model for end-stage liver disease (MELD) score were evaluated to predict morbidity and mortality. Results Of the patients (mean age, 60.4 ± 15 years; 31 men and 32 women), 14.3% had concomitant underlying diseases of renal insufficiency, 34.9% had diabetes mellitus, and 4.8% had pneumonia. Diaphragmatic blebs were the most common diaphragmatic defects (29 of 63 [46%]). After a median 20.5 months of follow-up examinations, 4 patients experienced recurrence. The 1-month mortality rate was 9.5% (6 of 63 patients). On multivariable analysis, underlying impaired renal function (p = 0.039) and MELD scores (p = 0.048) were associated with increased 3-month mortality in 16 patients. Contrary to the rising Child-Pugh score (p = 0.058), rising MELD scores represented an increase in kidney or liver failure and mortality. The main causes of 3-month mortality were septic shock (n = 6), acute renal insufficiency (n = 4), gastrointestinal bleeding (n = 4), hepatic encephalopathy (n = 1), and ischemic bowel (n = 1). Conclusions Thoracoscopic mesh repair for refractory HH improves symptoms and lowers the recurrence rate. ? 2016 The Society of Thoracic Surgeons.
SDGs
Other Subjects
creatinine; acute kidney failure; adult; Article; Child Pugh score; clinical trial; comorbidity; conservative treatment; creatinine blood level; critically ill patient; diaphragm disease; empyema; female; gastrointestinal hemorrhage; hepatic encephalopathy; hepatic hydrothorax; hospitalization; human; hydrothorax; kidney function; lung edema; major clinical study; male; middle aged; morbidity; outcome assessment; overall survival; paracentesis; peroperative complication; pleura effusion; pneumonia; priority journal; recurrence risk; septic shock; surgical risk; thoracocentesis; thoracoscopy; thorax surgery; transjugular intrahepatic portosystemic shunt; urine volume; aged; complication; diaphragm; hydrothorax; liver cirrhosis; mortality; postoperative care; procedures; recurrent disease; severity of illness index; surgical mesh; thoracoscopy; very elderly; Adult; Aged; Aged, 80 and over; Diaphragm; Female; Humans; Hydrothorax; Liver Cirrhosis; Male; Middle Aged; Postoperative Care; Recurrence; Severity of Illness Index; Surgical Mesh; Thoracoscopy
Publisher
Elsevier USA
Type
journal article