Diaphragmatic hernia after hepatic resection: case series at a single Western institution

Abstract

Background: Diaphragmatic hernia (DH) after hepatic resection (HR) is a rare and not well-described complication. We report our experience with DH following a high volume of HRs in a tertiary center.

Methods: Records of patients undergoing major HR for liver tumors between April 1992 and November 2011 were reviewed. The definitive diagnosis of DH was made based on radiologic studies. Primary repair was used for defects <10 cm in size. Transthoracic repair was used in patients with recurrent or complex hernias. Univariate analysis was performed to determine risk factors associated with posthepatectomy DH.

Results: DH developed in 10 out of 993 patients (1%) at a median time interval of 15 months after HR. DH was not associated with old age (m = 48.5 years), gender (male = 50%), or high body mass index (m = 24.5). However, mean tumor size was large (m = 9.2 cm). The majority of patients presented with symptoms (80 %), small (60%) and right-sided (80%) hernias, and underwent elective repair via an abdominal approach (70%). Large defects (>10 cm; 30%) were successfully repaired with prosthetic mesh. Increased incidence of DH was associated with diaphragmatic resection at the time of HR (5.4 vs. 0.7%, p = 0.001). At a median follow-up of 36 months (range, 10-167 months) after hernia repair, recurrence occurred in one patient.

Conclusion: Diaphragmatic resection at the time of HR and large tumor size may put patients at risk of developing posthepatectomy DH. Early detection and prompt treatment is associated with low recurrence and offers the advantage of primary repair.