Research Information System
8. INTERNATIONAL ANKARA MULTIDISCIPLINARY STUDIES CONGRESS, Ankara, Turkey, 16 - 18 March 2025, pp.451-454, (Summary Text)
ABSTRACT
Since the first successful liver transplantation was performed by T. Starzl in 1965, liver transplantation
has been the gold standard treatment for end-stage liver diseases, acute fulminant liver failure and some
primary liver tumours. In countries like our country where cadaver donation is low and the number of
patients in need of transplantation is very high, living donor liver transplantation has become an
alternative and frequently used surgical technique to cadaver liver transplantation.
The donor complication rate after living donor liver transplantation is between 10-40%. Although the
majority of these complications are simple complications such as Clavien grade 1-2 that do not require
repeat surgery or interventional procedures, serious complications such as haemorrhage, bile leakage
and ileus are also major complications that can be seen following this operation.
Diaphragmatic hernia is a rare (0.6-2%) complication following living donor liver transplantation and
is only seen as a case series in the literature. The main risk factors for diaphragmatic hernia in living
donors, especially after right lobe donor hepatectomy, are thermal damage to the diaphragm during
mobilisation of the right lobe of the liver, loss of the protective effect of the right lobe of the liver,
delayed healing due to continuous movement of the diaphragm, malnutrition and pressure differences
between the abdominal and thoracic cavities.
We aimed to present a case of diaphragmatic hernia, a rare donor complication, which developed in a
donor who underwent right lobe hepatectomy.
Case Report:
Forty-two-year-old female patient. The patient, who underwent donor right lobe hepatectomy about 7
years ago, presented to our outpatient clinic with complaints of difficulty in breathing, palpitations with
exertion and constipation for the last 2 months. On physical examination, decreased respiratory sounds
in the right haemithorax and bowel sounds were detected. Radiological examinations, PA-AC
radiography and thoracic tomography showed that the small intestine and colon protruded into the right
hemithorax (Image 1 and 2). The patient who had no signs of intestinal obstruction was reoperated under elective conditions. The intestinal anus protruding into the right hemithorax was taken into the abdomen
and the defect in the diaphragm was closed and repaired with mesh.
Conclusion:
Diaphragmatic hernia is a rare complication after donor hepatectomy which may cause morbidity and
mortality in patients with obstruction and strangulation. In these patients, the only treatment method is
surgery. Emergency surgical treatment should be performed immediately in patients with intestinal
obstruction or strangulation. Elective surgery can be performed in patients without signs of obstruction.
This rare complication should be kept in mind especially in patients who underwent right lobe donor
hepatectomy and complain of dyspnoea, tachypnoea, fatigue on exertion, constipation and diarrhoea.