Diaphragmatic hernia following liver resection: case series and review of the literature

Abstract

Backgrounds/AimsPostoperative diaphragmatic hernia, following liver resection, is a rare complication.MethodsData of patients who underwent major hepatectomy for liver tumors, between 2011 and 2015 were retrospectively reviewed. The literature was searched for studies reporting the occurrence of diaphragmatic hernia following liver resection.ResultsDiaphragmatic hernia developed in 2.3% of patients (3/131) with a median delay of 14 months (4-31 months). One patient underwent emergency laparotomy for bowel obstruction and two patients underwent elective diaphragmatic hernia repair. At last follow-up, no recurrences were observed. Fourteen studies including 28 patients were identified in the literature search (donor hepatectomy, n=11: hepatectomy for liver tumors, n=17). Diaphragmatic hernia was repaired emergently in 42.9% of cases and digestive resection was necessary in 28.5% of the cases. One patient died 3 months after hepatectomy, secondary to sepsis, from a segment of small bowel that perforated into the diaphragmatic hernia.ConclusionsAlthough rare, diaphragmatic hernia should be considered as an important complication, especially in living donor liver transplant patients. Diaphragmatic hernia should be repaired surgically, even for asymptomatic patients.

Diaphragmatic hernia following a liver resection: A rare cause of bowel obstruction

“…The literature contains some examples: after surgery most of the times [2][3][4][5][6], misplaced thoracic drain [7], and rarely from cardiopulmonary resuscitation [8].…”

“…Acquired diaphragmatic hernias are commonly due to traumatic disruptions of the diaphragm, following a severe trauma [1,2]. They are mainly due to penetrating than blunt trauma with a 2:1 ratio [9,10].…”

“…Francesco Esposito [2] conducted a study, including a liver surgery performed for four years, to evaluate the prevalence of right diaphragmatic hernias following liver resection. The incidence in their study was 2.3 % (3/131) which is in accordance with the literature (< 6.2% after liver resection).…”

“…The rate of a late presentation of an iatrogenic diaphragmatic hernia is disparate ranging from 5% to 62% of the cases [3], with delayed presentation occurring as late as many months or years after the supposedly harmful event [2,3,[11][12][13].…”

“…However, in a lesser rate, undiagnosed iatrogenic diaphragmatic injuries are revealed by an acquired hernia with or without complications. Diaphragmatic hernia after liver resection is rare, with an incidence ranging from 0.6% to 6.2% of the series described in the literature [2]. We report a case of a right diaphragmatic hernia following the resection of the right hepatic lobe, and revealed by a bowel obstruction syndrome two years after the surgery.…”