Link: https://www.ncbi.nlm.nih.gov/pubmed/30456575

Surg Case Rep. 2018 Nov 19;4(1):135. doi: 10.1186/s40792-018-0542-0.
Laparoscopic repair of an incarcerated diaphragmatic hernia after right hepatectomy for hepatic injury: a case report.
Takaichi S1, Takahashi T2, Funaki S3, Tanaka K1, Miyazaki Y1, Makino T1, Kurokawa Y1, Yamasaki M1, Nakajima K1, Okumura M4, Mori M1, Doki Y1.
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Abstract
BACKGROUND:
Diaphragmatic hernias (DH) are generally classified as either congenital or acquired. Acquired DH are generally of traumatic cause, being a rare complication after hepatectomy. Although repair of a DH can be performed via laparotomy, laparoscopy, or thoracoscopy, the use of laparoscopy is rare after hepatectomy owing to the formation of scar tissue. In this case, we describe our successful attempt at laparoscopic repair of a recurrent DH after hepatectomy.

CASE PRESENTATION:
A 30-year-old man underwent right hepatectomy for trauma and thoracotomy via the eighth intercostal space, with direct closure of the diaphragm by suturing. The patient subsequently developed a right DH, with strangulation ileus of the small intestine. He underwent laparotomy 3 months after the initial surgery. The defect was observed to be clearly separate from the previously sutured area of the diaphragm. Five years after treatment, the patient developed abdominal pain and vomiting due to incarceration of the transverse colon in the right intrathoracic space (detected via abdominal computed tomography and radiography). The patient was again diagnosed with DH and underwent laparoscopic repair of the hernia with direct closure. The patient was discharged 11 days after surgery without further complication.

CONCLUSIONS:
A laparoscopic approach was feasibly and safely used to repair a recurrent DH after hepatectomy. The surgical approach will need to be decided in a patient-specific manner.

KEYWORDS:
Diaphragmatic hernia; Laparoscopic surgery; Right hepatectomy

PMID: 30456575 DOI: 10.1186/s40792-018-0542-0