Advertisement

World Journal of Surgery

, Volume 43, Issue 3, pp 902–909 | Cite as

Enterothorax After Hepatic Surgery: A Single-Center Experience

  • G. Manzini
  • C. Kuemmerli
  • C. S. Reiner
  • H. Petrowsky
  • C. A. GutschowEmail author
Original Scientific Report (including Papers Presented at Surgical Conferences)

Abstract

Background

Enterothorax (ET) is a rare complication after hepatic surgery. The literature in this field is limited and mainly based on case reports. The aim of this study was to review our department’s experience.

Patients and methods

We retrospectively analyzed 602 patients who underwent hepatic resection between November 2008 and December 2016. Major hepatic surgery (n = 321) was defined as right or extended right hepatectomy (n = 227), left or extended left hepatectomy (n = 63), trisegmentectomy (n = 13), and living donor liver transplantation (n = 18). ET cases were identified by analyzing clinical courses and radiological imaging.

Results

ET was observed in five out of 602 patients (0.8%). All patients developed the complication after major hepatic surgery (five out of 321, 1.6%). ET exclusively occurred after right (n = 3) or extended right hepatectomy (n = 2). Median time to diagnosis was 22 months. Radiological imaging showed herniation of small (n = 2), large bowel (n = 2), or omental fat (n = 1) with a median diaphragmatic defect of 3.9 cm. Two patients presented with acute incarceration and underwent emergency surgery, one patient reported recurrent pain and underwent elective repair, and two patients refused surgery. Follow-up imaging in two operated patients showed no recurrence of ET after 36 and 8 months.

Conclusions

Patients after right hepatectomy have a substantial risk of ET. Acute right upper quadrant pain and/or dyspnea after hepatectomy should be investigated with adequate radiological imaging. Elective surgical repair of ET is recommended to avoid emergency surgery in case of incarceration.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional review board approval was obtained for this study (BASEC-Number 2017-01878).

References

  1. 1.
    Raakow J, Schulte-Mäter J, Andreou A et al (2017) Diaphragmatic herniation of abdominal contents: case series and review of the literature. Zentralbl Chir 142:113–121CrossRefGoogle Scholar
  2. 2.
    Rottier R, Tibboel D (2005) Fetal lung and diaphragm development in congenital diaphragmatic hernia. Semin Perinatol 29:86–93CrossRefGoogle Scholar
  3. 3.
    Johnson CD, Ellis H (1988) Acquired hernias of the diaphragm. Postgrad Med J 64:317–321CrossRefGoogle Scholar
  4. 4.
    Crandall M, Popowich D, Shapiro M et al (2007) Posttraumatic hernias: historical overview and review of the literature. Am Surg 73(9):845–850Google Scholar
  5. 5.
    Willer BL, Worrell SG, Fitzgibbons RJ Jr et al (2012) Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy. Hernia 16:185–190CrossRefGoogle Scholar
  6. 6.
    Johnson CD, Shandall A (1987) Incisional hernia of the diaphragm causing large bowel obstruction. J R Coll Surg Edinb 21:51–52Google Scholar
  7. 7.
    Ganeshan DM, Correa AM, Bhosale P et al (2013) Diaphragmatic hernia after esophagectomy in 440 patients with long-term follow-up. Ann Thorac Surg 96:1138–1145CrossRefGoogle Scholar
  8. 8.
    Benjamin G, Ashfaq A, Chang YH et al (2015) Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature. Hernia 19:635–643CrossRefGoogle Scholar
  9. 9.
    Wood TF, Rose DM, Chung M et al (2000) Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations and complications. Ann Surg Oncol 7:593–600CrossRefGoogle Scholar
  10. 10.
    Tabrizian P, Jibara G, Shrager B et al (2012) Diaphragmatic hernia after hepatic resection: case series at a single Western institution. J Gastrointest Surg 16:1910–1914CrossRefGoogle Scholar
  11. 11.
    Hawxby AM, Mason DP, Klein AS (2006) Diaphragmatic hernia after right donor and hepatectomy: a rare donor complication of partial hepatectomy for transplantation. Hepatobiliary Pancreat Dis Int 5(3):459–461Google Scholar
  12. 12.
    Vernadakis A, Paul A, Kykalos S et al (2012) Incarcerated diaphragmatic hernia after right hepatectomy for living donor liver transplantation: case report of a extremely rare late donor complication. Transplant Proc 44:2770–2772CrossRefGoogle Scholar
  13. 13.
    Jeng KS, Huang CC, Lin CK et al (2015). Early incarcerated diaphragmatic hernia following right donor hepatectomy: a case report. In: Transplantation proceedings, vol 47, pp 815–816Google Scholar
  14. 14.
    Yaprak O, Dayangac M, Tolga Demirbas B et al (2011) Analysis of right lobe living-liver donor complications: a single center experience. Exp Clin Transplant 1:56–59Google Scholar
  15. 15.
    Terminology Committee of the international Hepato-Pancreato-Biliary Association: Chairman, SM Strasberg (USA), Belghiti J, Clavien PA, Gadzijev E et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2(3):333–339CrossRefGoogle Scholar
  16. 16.
    Mullins ME, Stein J, Saini SS et al (2001) Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR 177:363–366CrossRefGoogle Scholar
  17. 17.
    Livingstone SM, Andres A, Shapiro J et al (2016) Diaphragmatic hernia after living donor right hepatectomy: proposal for a screening protocol. Transplant Direct 2(7):e84CrossRefGoogle Scholar
  18. 18.
    Kousoulas L, Becker T, Richter N et al (2011) Living donor liver transplantation: effect of the type of liver graft donation on donor mortality and morbidity. Transpl Int 24(3):251–258CrossRefGoogle Scholar
  19. 19.
    Perwaiz A, Mehta N, Mohanka R et al (2010) Right-sided diaphragmatic hernia in an adult after living donor liver transplant: a rare cause of post-transplant recurrent abdominal pain. Hernia 14:547–549CrossRefGoogle Scholar
  20. 20.
    Dieter RA Jr, Spitz J, Kuzycz G (2011) Incarcerated diaphragmatic hernia with intrathoracic bowel obstruction after right liver donation. Int Surg 96(3):239–244CrossRefGoogle Scholar
  21. 21.
    Yonemura Y, Umeda K, Kumashiro R et al (2013) Laparoscopic repair of incarcerated diaphragmatic hernia as a late complication of laparoscopic right hepatectomy: a case report. Fukuoka Igaku Zasshi 104(12):599–602Google Scholar
  22. 22.
    Mizuno S, Tanemura A, Isaji S (2014) Incarcerated left diaphragmatic hernia following left hepatectomy for living donor liver transplantation. Transpl Int 27(7):e65–e67CrossRefGoogle Scholar
  23. 23.
    Koda M, Ueki M, Maeda N et al (2003) Diaphragmatic perforation and hernia after hepatic radiofrequency ablation. Am J Roentgenol 180:1561–1562CrossRefGoogle Scholar
  24. 24.
    Sugita M, Nagahori K, Kudo T et al (2003) Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic surgery. Surg Endosc 17:1849CrossRefGoogle Scholar
  25. 25.
    Rochester DF, Arora NS, Braun NM (1982) Maximum contractile force of human diaphragm muscle, determined in vivo. Trans Am Clin Climatol Assoc 93:200–208Google Scholar
  26. 26.
    Price TN, Allen MS, Nichols FC 3rd et al (2011) Hiatal hernia after esophagectomy: analysis of 2,182 esophagectomies from a single institution. Ann Thorac Surg 92:2041–2045CrossRefGoogle Scholar
  27. 27.
    Van Sandick JW, Knegjens JL, van Lanschot JJ et al (1999) Diaphragmatic herniation following oesophagectomy. Br J Surg 86:109–112CrossRefGoogle Scholar
  28. 28.
    Vallbohmer D, Holscher AH, Herbold T et al (2007) Diaphragmatic hernia after conventional of laparoscopic-assisted transthoracic esophagectomy. Ann Thorac Surg 84:1847–1852CrossRefGoogle Scholar
  29. 29.
    Biere SS, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicenter, open-label, randomized controlled trial. Lancet 379:1887–1892CrossRefGoogle Scholar
  30. 30.
    Fumagalli U, Rosati R, Caputo M et al (2006) Diaphragmatic acute massive herniation after laparoscopic gastroplasty for esophagectomy. Dis Esophagus 19:40–43CrossRefGoogle Scholar
  31. 31.
    Kent MS, Luketich JD, Tsai W et al (2008) Revisional surgery after esophagectomy: an analysis of 43 patients. Ann Thorac Surg 86:975–983CrossRefGoogle Scholar
  32. 32.
    Messenger DE, Higgs SM, Dwerryhouse SJ et al (2015) Symptomatic diaphragmatic herniation following open and minimally invasive oesophagectomy: experience from UK specialist unit. Surg Endosc 29:417–424CrossRefGoogle Scholar
  33. 33.
    Oor JE, Wiezer MJ, Hazebroek EJ (2016) Hiatal hernia after open versus minimally invasive esophagectomy: a systematic review and meta-analysis. Ann Surg Oncol 23:2690–2698CrossRefGoogle Scholar
  34. 34.
    Kim JH (2018) Pure laparoscopic right hepatectomy using modified liver hanging maneuver: technical evolution from caudal approach toward ventral approach. J Gastroint Surg.  https://doi.org/10.1007/s11605-018-3736-7 (Epub ahead of print) Google Scholar
  35. 35.
    Guro H, Cho JY, Han HS et al (2018) Outcomes of major laparoscopic liver resection for hepatocellular carcinoma. Surg Oncol 27(1):31–35CrossRefGoogle Scholar
  36. 36.
    Marino MV, Shabat G, Guarrasi D et al (2018) Comparative study of the initial experience in performing robotic and laparoscopic right hepatectomy with technical description of the robotic technique. Dig Surg.  https://doi.org/10.1159/000487686 (Epub ahead of print) Google Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • G. Manzini
    • 1
  • C. Kuemmerli
    • 1
  • C. S. Reiner
    • 2
  • H. Petrowsky
    • 1
  • C. A. Gutschow
    • 1
    Email author
  1. 1.Department of Visceral and Transplantation SurgeryUniversity Hospital of ZurichZurichSwitzerland
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Hospital of ZurichZurichSwitzerland

Personalised recommendations