Abstract：
OBJECTIVE: Acquired post-transplant diaphragmatic hernia (PTDH) is a rare complication of liver transplantation (LT) in children. We aimed to present our experience in PTDH, and a possible causative background is discussed.
METHODS: Medical records of patients who had undergone diaphragmatic repair following LT between 2015 and 2023 were reviewed. Demographic information, details of primary diseases necessitating LT, transplantation techniques, and clinical findings associated with PTDH were evaluated.
RESULTS: There were seven patients with PTDH. Median age at transplantation was 69 (range: 9-200) months. Five patients received a left lateral sector, one patient had a right lobe, and one had a left lobe graft. Time between LT and PTDH was 9 (2-123) months. One patient who was diagnosed in the postoperative 10th year was asymptomatic. Respiratory distress and abdominal pain were the main symptoms among all. All patients underwent laparotomy, and primary repair was performed in six patients, and one patient required mesh repair because of a large defect. Small intestine herniated in most cases. There were two complicated cases with perforation of the stomach and colonic volvulus. There is no recurrence or long-term complications for the median 60 (20-119) month follow-up period.
CONCLUSIONS: PTDH is a rare but serious complication. Majority of symptomatic cases present within the first postoperative year, whereas some late-presenting cases may not be symptomatic. Inadvertent injury to the inferior phrenic vasculatures due to excessive use of cauterization for control of hemostasis may be a plausible explanation in those cases.
METHODS: Medical records of patients who had undergone diaphragmatic repair following LT between 2015 and 2023 were reviewed. Demographic information, details of primary diseases necessitating LT, transplantation techniques, and clinical findings associated with PTDH were evaluated.
RESULTS: There were seven patients with PTDH. Median age at transplantation was 69 (range: 9-200) months. Five patients received a left lateral sector, one patient had a right lobe, and one had a left lobe graft. Time between LT and PTDH was 9 (2-123) months. One patient who was diagnosed in the postoperative 10th year was asymptomatic. Respiratory distress and abdominal pain were the main symptoms among all. All patients underwent laparotomy, and primary repair was performed in six patients, and one patient required mesh repair because of a large defect. Small intestine herniated in most cases. There were two complicated cases with perforation of the stomach and colonic volvulus. There is no recurrence or long-term complications for the median 60 (20-119) month follow-up period.
CONCLUSIONS: PTDH is a rare but serious complication. Majority of symptomatic cases present within the first postoperative year, whereas some late-presenting cases may not be symptomatic. Inadvertent injury to the inferior phrenic vasculatures due to excessive use of cauterization for control of hemostasis may be a plausible explanation in those cases.
摘要：
目的：获得的移植后膈疝（PTDH）是儿童肝移植（LT）的罕见并发症。我们旨在介绍我们在PTDH的经验，并讨论了可能的致病背景。
方法：回顾了2015年至2023年之间在LT术后进行膈肌修复的患者的医疗记录。人口统计信息,需要LT的原发疾病的细节，移植技术,和与PTDH相关的临床发现进行了评估。
结果：有7例PTDH患者。移植时的中位年龄为69（范围：9-200）个月。五名患者接受了左外侧部分，一个病人有一个右叶,其中一个有左叶移植。LT和PTDH之间的时间为9（2-123）个月。一名在术后10年被诊断的患者无症状。呼吸窘迫和腹痛是主要症状。所有患者均行剖腹手术,对六名患者进行了一次修复，还有一个病人因为一个大的缺损而需要网片修复。小肠疝在大多数情况下。有2例复杂的胃穿孔和结肠扭转。中位60(20-119)个月随访期间无复发或长期并发症。
结论：PTDH是一种罕见但严重的并发症。大多数有症状的病例在术后第一年内出现，而一些晚期病例可能没有症状。在这些情况下，由于过度使用烧灼法来控制止血而对膈下血管的无意伤害可能是一个合理的解释。
方法：回顾了2015年至2023年之间在LT术后进行膈肌修复的患者的医疗记录。人口统计信息,需要LT的原发疾病的细节，移植技术,和与PTDH相关的临床发现进行了评估。
结果：有7例PTDH患者。移植时的中位年龄为69（范围：9-200）个月。五名患者接受了左外侧部分，一个病人有一个右叶,其中一个有左叶移植。LT和PTDH之间的时间为9（2-123）个月。一名在术后10年被诊断的患者无症状。呼吸窘迫和腹痛是主要症状。所有患者均行剖腹手术,对六名患者进行了一次修复，还有一个病人因为一个大的缺损而需要网片修复。小肠疝在大多数情况下。有2例复杂的胃穿孔和结肠扭转。中位60(20-119)个月随访期间无复发或长期并发症。
结论：PTDH是一种罕见但严重的并发症。大多数有症状的病例在术后第一年内出现，而一些晚期病例可能没有症状。在这些情况下，由于过度使用烧灼法来控制止血而对膈下血管的无意伤害可能是一个合理的解释。
