Thoracoscopic Mesh Repair of Diaphragmatic Defects for Hepatic Hydrothorax

Study Overview
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Brief Summary
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The management of refractory hepatic hydrothorax is challenging and usually unsuccessful. The study will discuss the perioperative treatment, effectiveness, and morphology of diaphragmatic defects of hepatic hydrothorax in thoracoscopic mesh repair. Risk factors associated with increased three-month mortality in these critically ill patients will be studied.

Detailed Description
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Objective The objective was to analyze the outcomes of thoracoscopic mesh repair for hepatic hydrothorax (HH) at the institution of the investigators 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.

Official Title
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Thoracoscopic Mesh Repair of Diaphragmatic Defects for Hepatic Hydrothorax: 10 Years' Experience From a Single Large-volume Center

Conditions
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Liver Cirrhosis

Intervention / Treatment
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* Procedure: thoracoscopic diaphragmatic repair


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with refractory hepatic hydrothorax (> 3 times thoracentesis and failure to maximal doses of diuretics) Exclusion Criteria: Patients with systemic bacteremia, positive culture of bacteria of pleural effusion or ascites were excluded from the study because of potential mesh contamination.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: thoracoscopic mesh repair group<br>63 patients with refractory HH (> 3 times thoracentesis and failure to maximal doses of diuretics) who underwent thoracoscopic diaphragmatic repair were included in this study. | Procedure: thoracoscopic diaphragmatic repair<br>* patients with refractory hepatic hydrothorax (> 3 times thoracentesis and failure to maximal doses of diuretics) who underwent thoracoscopic diaphragmatic repair<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| one-month mortality | one-month mortality after thoracoscopic mesh repair | one month | 
| three-month mortality | three-month mortality after thoracoscopic mesh repair | three month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| recurrence of hepatic hydrothorax | recurrence of hepatic hydrothorax after thoracoscopic mesh repair | 20.5 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hepatic hydrothorax, thoracoscopic surgery, diaphragmatic defect