Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):462-471. 10.14701/ahbps.2021.25.4.462.

Acquired diaphragmatic hernia after hepatectomy and liver transplantation in adults and children: A case series and literature review

• Martin V
• Gregoire E
• Chopinet S
• Scatton O
• Dubois R
• Lasseur A
• Dumortier J
• Boillot O

• KMID: 2523049
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.462

Abstract

Backgrounds/Aims
Acquired diaphragmatic hernia is a rare complication following liver surgery in adult and pediatric patients. This study aims to describe main features occurring in adult and pediatric patients after liver surgery and report an up-date review of the literature.
Methods
All adult and pediatric patients who were diagnosed with postoperative acquired diaphragmatic hernia in Lyon and Marseille University Hospitals were included in this study. Diagnosis, clinical, radiologic, and therapeutic data were analysed retrospectively from medical papers and/or electronic records.
Results
Thirteen adults with a median age of 50 years (range, 30–67 years) and 5 children aged 2.4 years (range, 0.9–4 years) were diagnosed with acquired diaphragmatic hernia after a median time of 65.1 (range, 1.8–244.7) and 2 (range, 0.33–10.9) months, respectively, following surgeries (5 live-donor right hepatectomies, 5 right and 1 left hepatectomies for tumors and cysts, and 2 whole liver transplantations in adults; and 5 liver transplantations with left lateral section in children). Eleven patients presented digestive and/or thoracic symptoms whereas seven were asymptomatic and diagnosed by routine imaging follow-up. All patients were re-operated with a median delay of 2.4 months (range, 0–25.3 months) for adults and 1 day (range, 0–2 days) for children. Two recurrences resulted in a secondary surgical repair.
Conclusions
Acquired diaphragmatic hernia is a rare and potentially serious event after liver surgery. Recognition and surgical repair of this particular complication should be considered in the setting of unexplained abdominal and/or thoracic symptoms. Preventive measures should be taken intraoperatively.

Keyword

Hernia; diaphragmatic; Hepatectomy; Liver transplantation; Adults and children; Surgery

Figure

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  Fig. 1 Computed tomography scan and operative views of a right acquired diaphragmatic hernia containing digestive elements in a live donor before (A, B) and after a diaphragmatic repair (C, D).

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  Fig. 2 Systematic protocol computed tomography-scan of an asymptomatic transplanted patient who had a whole liver graft 20 years ago, demonstrating part of the liver herniated into the pleural space (A) and its resolution after surgery through a thoracotomy approach (B).

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