OV06 EXTENDING THE INDICATIONS OF TRANSVERSUS ABDOMINIS RELEASE: SUBLAY MESH REPAIR FOR A RARE CASE OF ACQUIRED DIAPHRAGMATIC HERNIA

Aim Acquired diaphragmatic hernia (ADH) is rare and its treatment is challenging. Posterior component separation (PCS) with transversus abdominis release (TAR) is gaining wide acceptance for the repair of complex abdominal hernia, including those located in proximity of the abdominal borders. In this view the central tendon of the diaphragm could be intended as the rooftop border of the peritoneal sac. We describe an original application of TAR for the treatment of an unusual case of ADH. Material and Methods a 54 year-old man was referred to our department for an ADH, following two previous sternotomies for an aortic aneurysm, conditioning respiratory symptoms. A thoraco-abdominal contrast enhanced CT-scan confirmed an anterior left diaphragmatic defect with a transverse diameter of 8.5 cm and a huge sac containing the great omentum and the distal transverse colon, with atelectasis of the inferior lobe of the lung. A subxiphoid M1W2L2 incisional hernia was also detected. The patient underwent a midline xipho-umbilical laparotomy and a repair by partial TAR with posterior rectus sheath release and progressive dissection of the diaphragmatic muscular fibers far beyond the DH. A sublay repair with a large dual layer PVDF mesh was then accomplished. Results Postoperative course was uneventful and no recurrence was recorded at 6 months follow up. Conclusions partial-TAR could be a good option for repair of anteriorly placed ADH, ensuring a stable anatomical repair with an overlap that is usually wider than after laparoscopic IPOM repair. This novel indication confirms the extreme versatility of TAR for the repair of complex ventral hernia