Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty

Muysoms, Filip; Cathenis, Koen; Hamerlijnck, R; Claeys, D.

doi:10.1007/s10029-009-0551-9

Cited by 18 publications

(10 citation statements)

References 18 publications

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“…Most of the literature on omental flap reconstruction has reported diaphragmatic hernias, 6 but our case involved a defect in the abdominal wall. Hernia formation is a known complication of omental flap reconstruction, but a subxiphoid hernia presents a special challenge because of its location and the surrounding anatomy.…”

Section: Discussionmentioning

confidence: 79%

Laparoscopic Repair of a Subxiphoid Hernia After Omental Flap Reconstruction

Poris

Goldberg

Miner

2015

CRSLS

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Section: Discussionmentioning

confidence: 79%

Laparoscopic Repair of a Subxiphoid Hernia After Omental Flap Reconstruction

Poris

Goldberg

Miner

2015

CRSLS

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“…Muysoms et al [1] describe four cases of laparoscopic mesh repair of iatrogenic diaphragmatic hernia after sternectomy. A laparoscopic approach was initially chosen, but then converted to laparotomy with right subcostal incision.…”

Section: Discussionmentioning

confidence: 98%

“…Iatrogenic diaphragmatic hernia and intrathoracic intestinal herniation are described in literature after sternectomy and pedicled omentoplasty used for the treatment of deep sterna l wound infection [1] and it is a recognised complication after gastric and oesophageal surgery [1,2]. It is a very rare occurrence after cardiac surgery without complications.…”

Section: Introductionmentioning

confidence: 99%

Bowel obstruction after cardiac surgery due to diaphragmatic unrecognised hernia

Giuricin

Balani²,

Giacomel³

et al. 2011

Updates Surg

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Diaphragmatic hernia is a very rare occurrence after cardiac surgery without complications. We report a case of a 66-year-old male who underwent double aortocoronary bypass surgery, mitral and tricuspidal annuloplasty developed bowel obstruction 5 months after the operation. X-ray demonstrated small bowel loops in the left side of the chest. A laparoscopy was performed, but during the reduction of the hernia, patient suffered bradycardia because of adhesions between bowel and pericardical sac. Operation was interrupted and patient was transferred to our hospital where a cardiac surgery unit is present. No hemodynamic or respiratory deterioration was observed. Thoracic abdominal entero-CT, transthoracical echocardiography were performed. Patient underwent second surgery in cooperation with the cardial surgical team. Sternotomy was carried out. Hernial content was drawn onto the abdomen, diaphragmatic defect was closed with a direct suture. Mini-laparotomy was performed to exclude that the herniated small bowel did not have ischaemic suffering. No morbidity was observed in the post-operative course. This case illustrates the importance of an accurate pre-operative diagnosis in order to obtain information on relationship between loops of bowel and mediastinal organs. If sternotomy is required, surgical team must be supported by a cardiac surgical team.

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“…This method is effective in the setting of chronic injury repairs but is limited in the setting of an acute TDI with a contaminated field. Alternative methods in a contaminated field include the use of biologic mesh, vascularized tissue flaps, or a temporary absorbable mesh with plans for a delayed reconstruction [54][55][56][57]. A final challenging (although uncommon) situation is diaphragmatic avulsion from its attachments to the chest wall.…”

Section: Managementmentioning

confidence: 99%

“…These injuries can be extremely difficult to repair since the diaphragm retracts and shortens, making reapproximation impossible or prone to failure due to tension. An elegant solution to this is to perform a diaphragmatic transposition, by re-attaching the torn diaphragm edge to the chest wall several rib-spaces higher than normal [56,58,59].…”

Section: Managementmentioning

confidence: 99%

Penetrating Traumatic Diaphragm Injuries

DeBarros

Martin

2015

Curr Trauma Rep

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Traumatic diaphragm injuries (TDI) are uncommon but can result in major morbidity or mortality if missed. Penetrating thoracoabdominal injuries carry a high risk of TDI, but can also pose a diagnostic dilemma due to their small size and the frequent lack of an associated hernia. Despite advances in imaging, diagnosis without presence of a hernia remains difficult and a high index of suspicion must be maintained. Chest x-ray remains an important tool in early diagnosis, but primarily relies on the presence of a hernia or a discontinuity of the diaphragm, which is not typically seen with penetrating injuries. Computed tomography has a higher sensitivity and specificity and improves preoperative diagnosis, but most TDI are still diagnosed intra-operatively. Minimally invasive modalities allow for both diagnosis and repair of suspected injuries in hemodynamically stable patients while avoiding the morbidity of an open approach. All penetrating diaphragmatic injuries require repair in order to avoid the major morbidity and mortality of a chronic diaphragmatic hernia. The principles of diaphragmatic injury repair are complete reduction of all abdominal contents, lavage and evacuation of any associated hemothorax or gastrointestinal spillage, and watertight, tension-free closure. Most injuries can be closed primarily, but some may require use of prosthetic material or other advanced reconstructive techniques for larger defects. Mortality remains primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with overall Injury Severity Score serving as an independent predictor of early mortality.

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Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty

Abstract: We describe a laparoscopic technique to repair this difficult diaphragmatic hernia used in four patients, with a good clinical and computed tomographic outcome at 12 months.

Cited by 18 publications

References 18 publications

Laparoscopic Repair of a Subxiphoid Hernia After Omental Flap Reconstruction

Laparoscopic Repair of a Subxiphoid Hernia After Omental Flap Reconstruction

Bowel obstruction after cardiac surgery due to diaphragmatic unrecognised hernia

Penetrating Traumatic Diaphragm Injuries

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