Robotic repair of iatrogenic left diaphragmatic hernia. A case report

Highlights • Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery and it is associated with a high rate of misdiagnosis. • Patients with large diaphragmatic defects can be critically symptomatic immediately after surgery. • CT scan is the best imaging modality to diagnose diaphragmatic hernias. • Patients with chronic symptomatic hernia should undergo surgical repair of defect. • Robotic technology allows to perform an accurate dissection near important anatomic structures and it allows to suture in a confined space, which is technically challenging to approach with laparoscopic instruments.
Introduction Iatrogenic diaphragmatic hernia after laparoscopic left adrenalectomy has been rarely reported in adults. Surgery is the preferred treatment because of the risks of incarceration, strangulation and pulmonary complications. Presentation of case An elderly woman with parasternal diaphragmatic hernia has been successfully treated by robotic repair with mesh placement. The short-term follow-up showed that there was no recurrence or any symptoms after the intervention. Discussion Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery. The diagnosis could be challenging because of the presence of chronic symptoms. Computed tomography can be considered the gold standard technique to assess the correct diagnosis of diaphragmatic hernias in the majority of cases. Patients with chronic symptomatic hernia should undergo surgical repair of defect. Robotic technology because of its enhanced precision and the endowrist movement of the robotic arms, facilitates the dissection near the esophago-gastric junction and the other important adjacent structures. Conclusion Robotic technology seems to be a valid approach for the repair of diaphragmatic defects, even if this remains a high cost-related procedure.