Ann Hepatobiliary Pancreat Surg.  2017 Aug;21(3):114-121. 10.14701/ahbps.2017.21.3.114.

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

• Esposito F
• Lim C
• Salloum C
• Osseis M
• Lahat E
• Compagnon
• Azoulay D

• KMID: 2389987
• DOI: http://doi.org/10.14701/ahbps.2017.21.3.114

Abstract

BACKGROUNDS/AIMS
Postoperative diaphragmatic hernia, following liver resection, is a rare complication.
METHODS
Data 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.
RESULTS
Diaphragmatic 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.
CONCLUSIONS
Although 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.

Keyword

Diaphragmatic hernia; Liver resection; Repair; Systematic review

MeSH Terms

Emergencies
Follow-Up Studies
Hepatectomy
Hernia, Diaphragmatic*
Humans
Laparotomy
Liver*
Living Donors
Recurrence
Retrospective Studies
Sepsis

Figure

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  Fig. 1 Preoperative computed tomography showing the diaphragmatic hernia.

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  Fig. 2 Intraoperative view of the diaphragmatic hernia. (A) A white arrow shows the right colon flexure incarcerated in the hernia. (B) A white star shows the site of the hernia. (C) Primary closure of the hernia.

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  Fig. 3 Flow diagram showing the selection of studies reporting diaphragmatic hernia, following liver resection for systematic review.

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