Laparoscopic Repair of an Intrapericardial Diaphragmatic Hernia After Convergent Maze Procedure

Abstract

The convergent maze procedure (CMP) is a new minimally invasive technique for the surgical treatment of atrial fibrillation (AF). Recently, multiple groups have published excellent results and few adverse events with CMP. However, we now report the second case of an intrapericardial diaphragmatic hernia with small bowel obstruction that resulted from CMP. This adverse event was managed successfully by laparoscopic repair of the hernia and the use of a polytetrafluoroethylene mesh closure with hepatic buttress, achieving an excellent result. With the expanding use of CMP for the treatment of AF, awareness of this adverse event and its appropriate management are increasingly important.

Strangulated Intrapericardial Diaphragmatic Hernia after Hybrid Maze Procedure

“…At the end of procedure, usually a drain is placed to prevent cardiac tamponade. 5 It is very rare for the abdominal contents to herniate through this small defect in the diaphragm into the peri-cardial cavity. To our knowledge, this is the first case of a strangulated intrapericardial diaphragmatic hernia after hybrid ablation procedure in UK; and fourth case that has been reported in literature until now.…”

“…It is always desirable to involve senior members of surgical, anaesthetic and ITU teams including cardiologist. 5 As the hybrid technique for treatment of atrial fibrillation is gaining popularity these days, cardiologists involved in this procedure should be made aware of this rare but potentially life-threatening adverse event. Immediate closure of the diaphragmatic defect is recommended.…”

“…Till date, only three cases have been reported in literature about the rare complication of diaphragmatic hernia after maze procedure. 5,6 We report a rare case of potentially life-threatening complication of this procedure -strangulated hernia through the diaphragmatic window into the pericardium in a patient who had undergone surgical epicardial ablation in the past.…”

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

“…[ 57 ] This change eliminated the rare complication of bowel herniation into the thoracic space via the transabdominal, transdiaphragmatic approach, while still allowing the surgeon sufficient access to the posterior left atrium. [ 58 – 60 ] These changes have enhanced efficacy, as well as the safety profile of the procedure.…”