Abstract
Background
Diaphragmatic hernia (DH) after hepatic resection (HR) is a rare and not well-described complication. We report our experience with DH following a high volume of HRs in a tertiary center.
Methods
Records of patients undergoing major HR for liver tumors between April 1992 and November 2011 were reviewed. The definitive diagnosis of DH was made based on radiologic studies. Primary repair was used for defects <10 cm in size. Transthoracic repair was used in patients with recurrent or complex hernias. Univariate analysis was performed to determine risk factors associated with posthepatectomy DH.
Results
DH developed in 10 out of 993 patients (1 %) at a median time interval of 15 months after HR. DH was not associated with old age (m = 48.5 years), gender (male = 50 %), or high body mass index (m = 24.5). However, mean tumor size was large (m = 9.2 cm). The majority of patients presented with symptoms (80 %), small (60 %) and right-sided (80 %) hernias, and underwent elective repair via an abdominal approach (70 %). Large defects (>10 cm; 30 %) were successfully repaired with prosthetic mesh. Increased incidence of DH was associated with diaphragmatic resection at the time of HR (5.4 vs. 0.7 %, p = 0.001). At a median follow-up of 36 months (range, 10–167 months) after hernia repair, recurrence occurred in one patient.
Conclusion
Diaphragmatic resection at the time of HR and large tumor size may put patients at risk of developing posthepatectomy DH. Early detection and prompt treatment is associated with low recurrence and offers the advantage of primary repair.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Willemse P, Schutte PR, Plaiser PW. Thoracoscopic repair of a Bochdalek hernia in an adult. Surg Endosc 2003;17:162.
Johnson CD, Ellis H (1988) Acquired hernias of the diaphragm. Postgrad Med J 64:317–321
Rubikas R. Diaphragmatic injuries. Eur J Cardiothor Surg 2001;20:53-57.
Wood TF, Rose M, Chung M, Allegra DP, Foshag LJ, Bilchik AJ. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Onc 2000;7:593-600.
Sugita M, Nagahori K, Kudo T, Yamanaka K, Obi Y, Shizawa R, et al. Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic surgery. Surg Endosc 2003;17:1849-1850.
Koda M, Ueki M, Maeda N et al (2003) Diaphragmatic perforation and hernia after hepatic radiofrequency ablation. Am J Roentgenol 180:1561–1562
Hawxby AM, Mason DP, Klein AS. Diaphragmatic hernia after right donor and hepatectomy: a rare donor complication of partial hepatectomy for transplantation. Hepatobiliary Pancreat Dis Int. 2006 Aug;5(3):459-61.
Matz D, Kirchhoff P, Kocher TM et al. Consecutive cecum perforation due to incarcerated diaphragmatic hernia after liver surgery. Int J Colorectal Dis. 2009 Nov;24(11):1353-4
Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Buchler MW. Missed diaphragmatic injuries and their long-term sequelae. J Trauma 1998;44:183-188.
Eren S, Ciriş F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol. 2005 Jun;54(3):448-59
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tabrizian, P., Jibara, G., Shrager, B. et al. Diaphragmatic Hernia After Hepatic Resection: Case Series at a Single Western Institution. J Gastrointest Surg 16, 1910–1914 (2012). https://doi.org/10.1007/s11605-012-1982-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-012-1982-7