Related Experiment Video
Updated: Apr 5, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Thoracoscopic Approach for Repair of Diaphragmatic Hernia Occurring After Pediatric Liver Transplant
Sanghoon Lee1, Jeong-Meen Seo, Alaa Essam Younes
1From Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Diaphragmatic hernias after pediatric liver transplants are rare. A minimally invasive thoracoscopic approach is a feasible surgical option for repair in select pediatric patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Thoracic Surgery
Background:
- Diaphragmatic hernia (DH) is a rare complication following pediatric liver transplantation (LT).
- Historically, surgical repair of DH has been performed via laparotomy.
Observation:
- This study retrospectively reviewed 7 pediatric LT recipients with DH, attempting thoracoscopic repair in 3 cases.
- Case 1: Successful thoracoscopic repair of left-sided DH in a 12-month-old post-LT for biliary atresia.
- Case 2: Thoracoscopic repair of right-sided DH with bowel repair in a 13-month-old post-LT for biliary atresia.
- Case 3: Thoracoscopic repair attempted but laparotomy required for DH with bowel resection and anastomosis due to adhesions and necrosis.
Findings:
- Thoracoscopic repair was feasible in 2 out of 3 pediatric LT recipients with DH.
- Successful outcomes were achieved in cases without significant intra-abdominal complications or adhesions.
Implications:
- Minimally invasive thoracoscopic repair of DH is a viable option in experienced pediatric surgical centers.
- Careful patient selection is crucial for successful thoracoscopic DH repair post-LT.
- This approach may offer benefits over traditional laparotomy for selected pediatric liver transplant recipients.
Abstract:
Diaphragmatic hernias (DH) occurring after pediatric liver transplantation (LT) are rare. However, such complications have been previously reported in the literature and treatment has always been surgical repair via laparotomy. We report our experience of minimally invasive thoracoscopic approach for repair of DH occurring after LT in pediatric recipients.From April 2010 to December 2014, 7 cases of DH were identified in pediatric LT recipient in Samsung Medical Center. Thoracoscopic repair was attempted in 3 patients. Patients' medical records were retrospectively reviewed.Case 1 was a 12-month-old boy, having received deceased donor LT for biliary atresia (BA) 5 months ago. He presented with dyspnea and left-sided DH was detected. Thoracoscopic repair was successfully done and the boy was discharged at postoperative day 7. Case 2 was a 13-month-old boy, having received deceased donor LT for BA 2 months ago. He presented with vomiting and right-sided DH was detected. Thoracoscopic repair was done along with primary repair of herniated small bowel that was perforated while attempting reduction into the peritoneal cavity. The boy recovered from the surgery without complications and was discharged on the 10th postoperative day. Case 3 was a 43-month-old girl, having received deceased donor LT for Alagille syndrome 28 months ago. She was diagnosed with right-sided DH during steroid pulse therapy for acute rejection. Thoracoscopic repair was attempted but a segment of necrotic bowel was noticed along with bile colored pleural effusion and severe adhesion in the thoracic cavity. She received DH repair with small bowel resection and anastomosis via laparotomy.Thoracoscopic repair was attempted in 3 cases of DH occurring after LT in pediatric recipients. With experience and expertise in pediatric minimally invasive surgery, thoracoscopic approach is feasible in this rare population of patients.
