Journal Article

Diaphragmatic Hernias after Living Donor Hepatectomy: A Critical Reappraisal

Markakis, Charalampos, Vailas, Michail, Moris, Demetrios, Dimitrokallis, Nikolaos, Vernadakis, Spiridon, Spartalis, Eleftherios

2016

Overview

Donor morbidity rates vary between 0 and 67 per cent depending on the definition and the recognition of them.1 Donor mortality has been estimated between 0.2 and 0.9 per cent.1 Most commonly reported complications are infections, development of incisional hernias, biliary complications (stricture or leakage), respiratory complications (pleural effusions, atelectasis, pneumonia, and pulmonary embolism), vascular complications (bleeding and portal vein thrombosis), and postoperative liver failure.1 Diaphragmatic hernia (DH) affecting the donor is a rare complication with nine cases reported so far. [...]the vast majority of reports about this complication refer to donors that have undergone emergency surgery with a DH diagnosed on admission.1-4 On every report the diagnosis had been established with a thorax-abdomen CT scan with a better depiction on a coronal reformation.1-3 It is the failure to diagnose the hernia earlier, that has led the patients to emergency surgery and around 25 per cent of them had to undergo intestine resection.1, 3 Hypothesized causes for iatrogenic DH have been many such as direct trauma to the diaphragm during the operation, thermal or cryoinjury caused by coagulation or ablation instruments used during surgery and solutions used for cardiac surgery and diaphragmatic injury during laparoscopic liver resection or bariatric surgery.1 In the cases reviewed, there were no indications of congenital weaknesses or defects of the diaphragm during the liver procurement.

• Publisher: SAGE Publications,SAGE PUBLICATIONS, INC
• Subject: Abdomen / Adult / Emergency medical care / Gastrointestinal surgery / Hepatectomy / Hernia, Diaphragmatic - diagnosis / Hernia, Diaphragmatic - etiology / Hernia, Diaphragmatic - surgery / Hernias / Humans / Liver Transplantation / Living Donors / Medical imaging / Middle Aged / Morbidity / Mortality / Ostomy / Outcome Assessment (Health Care) / Patients / Postoperative Complications - diagnosis / Postoperative Complications - surgery / Tissue and Organ Harvesting / Transplants & implants