Pediatric Thoracoscopic Repair of Diaphragmatic Herniation Following Liver Transplantation

Diaphragmatic Hernia (DH) after Liver Transplantation (LT) is a rare complication with unclear pathophysiology. Among 261 LT, we recognized six DH during the post transplant period (2.30%). All patients with DH had received a left lateral segment (LLS) reduced graft. The mean graft weight was 340g with a mean graft-to-recipient body weight ratio (GBWR) of 4.20%. LLS grafts, a GBWR > 4%, previous abdominal surgery and direct trauma during surgery can be enumerated as potential risk factors for DH post-LT. These children underwent prompt surgical intervention to DH without complications. Three patients were treated via laparotomy and three by thoracoscopy. No clinical recurrences were accounted at a mean follow up of 5 years. Historically, the treatment has always been surgical repair via laparotomy but the use of minimally invasive techniques in pediatric surgery has been increasing, and the thoracoscopic approach for DH can bring advantages. The patients in which the thoracoscopic approach was used had shorter operative times and a faster recovery with better cosmetic results. As previous surgical manipulation had been done to the abdominal cavity, thoracoscopy seems to be a safe approach in DH in pediatric LT recipients.