Intrapericardial Diaphragmatic Hernia after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery Graft: Report of a Case

Abstract

Surgeons should be aware of diaphragmatic hernia in obese patients who have undergone coronary artery bypass grafting (CABG) using a gastroepiploic artery graft (GEA), even if the antegastric route is utilized. We report a case of diaphragmatic hernia, which occurred 88 months after initial CABG. A 64-year-old obese man underwent surgical repair of a diaphragmatic hernia. At initial surgery, the diaphragm was incised vertically and re-sutured, leaving a route for GEA graft. Both the stomach and the lateral segment of the liver were dislocated in the pericardial space. The diaphragmatic defect was closed with a polytetrafluoroethylene patch.

A Rare Variant of Diaphragmatic Hernia through the Central Tendon: A Case Report

“…Mostly, this complication has been known to develop after esophagectomy and nephrectomy [3]. The occurrences of hernia through the central tendon of the diaphragm as a delayed complication of CABG have been reported, but they were the cases of diaphragmatic hernia after CABG when gastroepiploic artery was used as a graft [4]. Our patient had CABG done with long saphenous venous graft.…”

Transdiaphragmatic-pericardial Hernia: Case Report of an Unusual Condition Managed by Utilization of a Robotic Surgical System

“…TDPH is a rare condition. It can occur due to diaphragmatic-pericardial defects that are usually the sequelae of traumatic injuries or the iatrogenic creation of a defect [3][4][5][6]. Iatrogenic defects most often follow coronary bypass surgery, particularly when using a right gastroepiploic artery graft, following subxiphoid procedures, including pericardial window or procedures for atrial fibrillation or after esophagectomy [1][2][3].…”

“…It can occur due to diaphragmatic-pericardial defects that are usually the sequelae of traumatic injuries or the iatrogenic creation of a defect [3][4][5][6]. Iatrogenic defects most often follow coronary bypass surgery, particularly when using a right gastroepiploic artery graft, following subxiphoid procedures, including pericardial window or procedures for atrial fibrillation or after esophagectomy [1][2][3]. The herniation of abdominal contents is a result of pressure differences between the abdomen and thoracic cavity and may involve any of the abdominal hollow viscus organs [7][8][9] The clinical presentation of TDPH may be variable.…”

“…In this process, the pericardium needs to be opened to approach the heart. Following this approach, the pericardium is typically not closed after and can lead to a potential defect [1][2][3]. This defect can lead to a rare complication called transdiaphragmatic-pericardial hernia (TDPH).…”

Laparoscopic repair of a peritoneopericardial diaphragmatic hernia after a convergent procedure for the treatment of atrial fibrillation

“…Iatrogenic causes of peritoneopericardial diaphragmatic hernia have been described following various surgical procedures within both the thoracic and abdominal cavity (3). One well documented example is due to placement of a mediastinal drain through the peritoneum following a coronary artery bypass grafting (CABG) procedure (6,7). Other examples include hernia following laparoscopic procedures such as liver transplant, cholecystectomy, hepatectomy, splenectomy, and gastrectomy (3).…”