Laparoscopic Repair of a Diaphragmatic Hernia Associated with Radiofrequency Ablation for Hepatocellular Carcinoma: Lessons from a Case and the Review of the Literature

Abstract

We describe the case of a patient with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was successfully treated by laparoscopic surgery. A 62-year-old man with a long history of hepatitis C-induced liver cirrhosis was admitted to our institution because of recurrent postprandial periumbilical pain. Eight years earlier, he had undergone radiofrequency ablation for hepatocellular carcinoma at hepatic segment VIII. Computed tomography, gastrografin enema examination revealed transverse colon obstruction because of a diaphragmatic hernia. We diagnosed diaphragmatic hernia associated with the prior radiofrequency ablation treatment. The patient underwent laparoscopic repair of the diaphragmatic hernia. Though the patient experienced the recurrence once, relaparoscopic treatment has improved the patient's conditions. Thus, diaphragmatic hernia can develop as a complication of radiofrequency ablation treatment. A laparoscopic approach is safe, feasible, and minimally invasive, even in patients with cirrhosis who develop iatrogenic diaphragmatic hernia as a complication of radiofrequency ablation treatment.

Fatal Diaphragmatic Hernia following Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report and Literature Review

“…Although RFA shows satisfactory local tumor control and minimal invasiveness, it often causes complications, including death, hemorrhage, needle-track seeding, intrahepatic abscess, perforation of gastrointestinal viscus, liver failure, biloma, biliary stricture, portal vein thrombosis, hemothorax, and pneumothorax [ 4 , 7 , 8 , 9 , 10 ]. Recently, iatrogenic diaphragmatic hernia accompanied by RFA, a rare but important complication, has been reported [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Therefore, we reviewed a total of 10 case reports (articles written in English obtained from PubMed) documenting diaphragmatic hernia following RFA for HCC and compared the clinical conditions of these and the present patient (table 2 ).…”

Radiofrequency Ablation-Associated Delayed Diaphragmatic Hernia Treated with the Thoracolaparotomy Approach: A Case Report

“…The surgical methods for the hernia repair were as follows: simple ligation in six cases, Vicryl patch in one case, and mesh in one case. Nomura et al [16] performed closure by using a mesh without intestinal resection. Concerning the surgical outcomes, no infectious complications occurred in patients with Vicryl patch and mesh.…”

Laparoscopic Repair of Diaphragmatic Perforation with Colonic Herniation Following Hepatic Radiofrequency Ablation: A Case Report

“…Nomura et al [18] mentioned that the temporal adhesion between the thermally-damaged diaphragm and the liver surface released due to the atrophy of the cirrhotic liver and develop a delayed diaphragmatic hernia. Singh et al [10] advocated that the thermal injury to the diaphragm did not cause a defect immediately, with the partial thermal injury instead resulting in an inflammatory response that led to fibrosis, ultimately weakening and causing a defect.…”

“…Diaphragmatic perforation and herniation are rare but serious complications of hepatic RFA. Since Koda et al [14] reported the first case of diaphragmatic hernia following RFA, there have been only 12 reported cases of RFA-associated iatrogenic diaphragmatic hernia written in English according to PubMed (Table 1), [10][11][12][13][14][15][16][18][19][20][21].…”

“…However, owing to modern advances in laparoscopic surgery laparoscopic repair has frequently been performed in more recent cases. Laparoscopic approaches to diaphragmatic repair have been introduced in the elective setting [10,18]. The laparoscopic approach is widely accepted as the safer surgical approach in patients with HCC and cirrhosis reducing ascites or pleural effusion than conventional laparotomy [23].…”