The simplicity of en bloc resection of diaphragm and liver tumours: a safe and effective technique of primary diaphragmatic repair with low respiratory-related morbidities

Abstract

Introduction: En bloc resection of diaphragm-involved liver tumours is essential to avoid tumour spillage resulting and adverse oncological outcomes. Diaphragm resection commonly results in respiratory morbidities, up to 25% in previous reports. This study aims to review the respiratory-related morbidities and mortality in a series of patients surgically treated with en bloc diaphragm and liver resection. Methods: Liver resection with diaphragmatic excision was performed in 13 patients. Diaphragmatic defect was primarily closed in the coronal plane with initial approximation of diaphragmatic edges using 2–0 prolene sutures from lateral to medial. A Yankauer suction tip was inserted through the middle of the remaining defect to evacuate iatrogenic pneumothorax with subsequent continuation of suturing crossing over the suction tip. Valsalva manoeuvre applied, the suction tip was withdrawn synchronously with tightening of both sutures. Following removal of Valsalva manoeuvre, sutures were advanced and subsequently terminated at the contralateral ends from their starting points. Results: Between January 2007 and September 2015, a total of 515 patients with liver tumours were surgically treated by the senior author (KH). Of these, 13 patients with liver tumours contiguously involving the diaphragm were identified. Resection was performed for 11 malignant liver tumours and 2 benign lesions. Post-operatively, one patient required intercostal catheter (ICC) insertion for symptomatic pleural effusion. No other morbidity was observed. There was no peri-operative mortalities. Conclusion: The described technique of primary diaphragmatic repair is relatively safe with 1 case of pleural effusion requiring ICC drainage post-operatively and no perioperative mortalities.