Tsunoda J, Nishi T, Ito T, Inaguma G, Matsuzaki T, Seki H, Yasui N, Sakata M, Shimada A, Matsumoto H. Laparoscopic repair of diaphragmatic hernia associating with radiofrequency ablation for hepatocellular carcinoma: A case report. World J Clin Cases 2022; 10(20): 7020-7028 [PMID: 36051126 DOI: 10.12998/wjcc.v10.i20.7020]
Corresponding Author of This Article
Tomohiko Nishi, MD, PhD, Deputy Director, Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai Nishi-ku, Yokohama 220-8521, Japan. brilliantladybird@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Junya Tsunoda, Tomohiko Nishi, Gaku Inaguma, Tomohiko Matsuzaki, Hiroaki Seki, Nobutaka Yasui, Michio Sakata, Akihiko Shimada, Hidetoshi Matsumoto, Department of Surgery, Keiyu Hospital, Yokohama 220-8521, Japan
Takafumi Ito, Department of Internal Medicine, Keiyu Hospital, Yokohama 220-8521, Japan
Author contributions: Tsunoda J interpreted the patient data based on the case notes and drafted the manuscript; Nishi T performed the surgery and supervised the manuscript; all other members equally contributed to the medical treatment.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomohiko Nishi, MD, PhD, Deputy Director, Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai Nishi-ku, Yokohama 220-8521, Japan. brilliantladybird@yahoo.co.jp
Received: November 15, 2021 Peer-review started: November 15, 2021 First decision: April 16, 2022 Revised: April 21, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: July 16, 2022 Processing time: 231 Days and 19 Hours
Abstract
BACKGROUND
Radiofrequency ablation (RFA) is an effective treatment for early-stage hepatocellular carcinoma (HCC). Although RFA is a relatively safe technique compared with surgery, several complications have been reported to be following/accompanying this treatment. Delayed diaphragmatic hernia caused by RFA is rare; however, the best surgical approach for its treatment is uncertain. We present a case of laparoscopic repair of diaphragmatic hernia due to RFA.
CASE SUMMARY
An 80-year-old woman with segment VIII HCC was treated twice in 5 years with RFA; 28 mo after the second RFA, the patient complained of right hypochondriac pain. Computed tomography revealed that the small intestine was incarcerated in the right thorax. The patient was diagnosed with diaphragmatic hernia and underwent laparoscopic repair by non-absorbable running sutures. The patient’s postoperative course was favorable, and the patient was discharged on postoperative day 12. The diaphragmatic hernia has not recurred 24 mo after surgery.
CONCLUSION
Laparoscopic treatment of iatrogenic diaphragmatic hernia is effective and minimally invasive.
Core Tip: Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC). Delayed diaphragmatic hernia caused by RFA is uncommon; however, the best surgical approach to its treatment has not been determined. Herein, we present a rare case of delayed-onset diaphragmatic hernia due to RFA and its treatment with laparoscopic repair. This case highlights the ultimate importance of that RFA for HCC located close to the diaphragm should be performed using artificial ascites under computed tomography guidance to prevent an injury to the diaphragm. Laparoscopic treatment of iatrogenic diaphragmatic hernia is effective and minimally invasive.
