{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:54:35Z","timestamp":1792374875640,"version":"4.4.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T00:00:00Z","timestamp":1579478400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100002456","name":"Chonnam National University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002456","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Treatment of refractory hepatic hydrothorax, a complication of liver cirrhosis, is complex. We aimed to investigate the usefulness of the \u20184-step approach\u2019, 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Diaphragmatic defects were localized in all patients except one. The median postoperative positive-pressure ventilation duration was 20.1\u2009h. Peritoneal drainage was performed for a median duration of 5\u2009days; 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\u2009days. No operative mortalities occurred. The median duration of follow-up was 10.9\u2009months. 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The 4-step approach seems to be a safe and effective minimally invasive surgical strategy for treating refractory hepatic hydrothorax.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezz342","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T20:09:16Z","timestamp":1573848556000},"page":"881-887","source":"Crossref","is-referenced-by-count":10,"title":["Minimally invasive surgical strategy for refractory hepatic hydrothorax"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-3007","authenticated-orcid":false,"given":"Yochun","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Yun","family":"Song","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kook Joo","family":"Na","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon-Ho","family":"Chon","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung Hwan","family":"Jun","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Kyu","family":"Choi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,1,20]]},"reference":[{"key":"2020042307462049000_ezz342-B1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1159\/000346996","article-title":"Evidence-based review of the management of hepatic 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