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Table of Contents
CASE REPORTS
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 89-90

Diaphragmatic hernia repair using uniportal video-assisted thoracoscopic surgery: A case report


1 Division of Trauma, Gold Coast University Hospital, Southport, Australia
2 Division of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Australia

Date of Submission21-Jun-2021
Date of Decision26-Jul-2021
Date of Acceptance20-Aug-2021
Date of Web Publication19-May-2022

Correspondence Address:
Dr. Bhavik Patel
Division of Trauma, Gold Coast University Hospital, 1, Hospital Boulevard, Southport 4215
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijawhs.ijawhs_39_21

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  Abstract 

The objective of this case study is the management of small necked diaphragmatic hernia in a patient with hostile abdomen. Case study describes the technique of uniportal video-assisted thoracoscopic surgery (U-VATS) for management of diaphragmatic hernia. This is a novel case for the management of diaphragmatic hernia using a patch utilizing minimally invasive cardiac surgical instrumentation via U-VATS approach. U-VATS is a feasible option for the management of diaphragmatic hernia in a patient with hostile abdomen.

Keywords: Cor-Knot, diaphragmatic hernia, patch graft, uniportal video-assisted thoracoscopic surgery


How to cite this article:
Patel B, Provenzano SE. Diaphragmatic hernia repair using uniportal video-assisted thoracoscopic surgery: A case report. Int J Abdom Wall Hernia Surg 2022;5:89-90

How to cite this URL:
Patel B, Provenzano SE. Diaphragmatic hernia repair using uniportal video-assisted thoracoscopic surgery: A case report. Int J Abdom Wall Hernia Surg [serial online] 2022 [cited 2022 Jul 1];5:89-90. Available from: http://www.herniasurgeryjournal.org/text.asp?2022/5/2/89/345511




  Introduction Top


A 66-year-old woman presented to the emergency department with a history of fall down a steep driveway face first under the influence of alcohol. The history included an orthotopic liver transplant for alcoholic liver disease and was currently on tacrolimus. On clinical examination, she was maintaining her own airway with no hemodynamic compromise. Because of the mechanism of injury and immunocompromised status trauma series computed tomography (CT) was carried out [Figure 1].
Figure 1: Portal venous phase CT scan suggestive of narrow neck (1.5 cm) diaphragmatic hernia

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This demonstrated nasal bone fractures and an incidental finding of the small neck (1.5 cm), moderate size (10 cm × 5 cm), right-sided diaphragmatic hernia with omentum as content. The radiological findings were discussed with the original transplant surgeon who did concur that the hernia has increased in size. In view of the small neck, increasing content within the sac, immunocompromised status, and previous major abdominal surgery, we decided to offer uniportal video-assisted thoracoscopy (U-VATS) procedure.


  Procedure Top


The procedure was conducted under anesthesia via a double lumen tube with the patient in the lateral position. The thoracic cavity was entered via a muscle-sparing 3-cm incision at the mid-axillary line on the fifth intercostal space. [Figure 2] demonstrates the moderate-size hernia with a narrow neck. The sac was opened, viable omentum as content was confirmed, and both were simply reduced.
Figure 2: Intraoperative picture of hernia with narrow neck (1.5 cm) and moderate size (10 × 5 cm) with omentum as content

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Hernial defect was closed using a 2.0 braided polyester suture (Ti-Cron, Medtronic, Minneapolis, MN), with a 3-cm circular patch of expanded polytetrafluoroethylene (ePTFE, Gore-Tex patch, original size: 150 mm × 200 mm × 2 mm, W. L. Gore and Associates, Inc., Flagstaff, AZ), and Cor-Knot mini device kit. The patch was used to overlap the edges, and a topic hemostatic agent (FLOSEAL, U.S. Baxter International Inc., Deerfield, IL) was applied [Figure 3]. A paravertebral catheter was inserted for pain relief, and an intercostal catheter was temporarily used to evacuate the thoracic cavity being removed on the beginning of port site closure. The Patient was extubated on a table, spend 24 h in the High Dependency Unit, and was discharged on day 4 following surgery.
Figure 3: Intraoperative picture of PTFE plug with polyester sutures

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  Discussion Top


Diaphragmatic hernias are well reported after liver transplantation in pediatric population.[1] Case reports of adult diaphragmatic hernia following transplantation managed with thoracotomy are well published.[2] This is, however, the first case to our knowledge in the management of diaphragmatic hernia in a liver transplant patient using the U-VATS approach. The rationale behind the operation was to avoid an emergency thoracotomy for torsion of omental content in a narrow neck hernia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang K, Gao W, Ma N, Meng X-C, Zhang W, Sun C, et al. Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation: Three cases report and review of literature. Medicine (Baltimore) 2018;97:e0346.  Back to cited text no. 1
    
2.
Steinbrück K, Fernandes R, Enne M Diaphragmatic hernia after adult orthotopic liver transplantation: A rare surgical complication associated to immunosuppression? J Clin Case Rep 2015;5:11.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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