The hepatic buttress: A novel surgical technique to treat an intrapericardial diaphragmatic defect after hybrid myocardial ablation

Abstract

Figure 2, B and C). The patient's dyspnea has since resolved. For the past 18 months, the patient has had no evidence of disease with regular follow-ups with surveillance CT scans. DISCUSSIONRecurrent metastatic disease after nephrectomy for RCC is relatively common, occurring in 20% to 50% of patients. The prognosis of metastatic RCC is poor, demonstrating a 6-to 12-month median overall survival and a 10% to 20% 2-year overall survival. 2 The lungs are the most common location for RCC metastases, accounting for the location of 45% to 75% of all metastatic disease. 3 Pulmonary metastasectomy appears to yield favorable results in certain patients, although these individuals largely have a high performance status with generous pulmonary reserve. Moreover, the biology of the cancer is important, because patients with shorter disease-free intervals and those with large (>3 cm) metastases have poorer outcomes. 3 Pleural metastases of RCC are relatively rare. 4,5 Autopsy data have demonstrated that 12% of all patients with metastatic RCC have pleural involvement, involvement that is invariably associated with pulmonary metastasis. 4While cases of pleural RCC metastasis are generally thought to occur from direct extension of lung parenchymal RCC metastases, some cases of pleural RCC, such as that described here, occur without lung metastases. In such cases, it has been suggested that pleural metastases may occur by way of the Batson venous plexus. 5 Although pulmonary metastasectomy is considered by many to be reasonable for metastatic parenchymal RCC, a pleurectomy and decortication procedure for pleural RCC metastases has never been reported to the best of our knowledge. We present here a case study of a pleurectomy and decortication procedure for pleural metastatic RCC that provided excellent symptom relief and local control. References1. Sugarbaker DJ, Wolf AS. Surgery for malignant pleural mesothelioma. Expert Rev Respir Med. 2010;4:363-72. 2. Flanigan RC, Campbell SC, Clark JI, Picken MM. Metastatic renal cell carcinoma. Curr Treat Options Oncol. 2003;4:385-90. 3. Kim DY, Karam JA, Wood CG. Role of metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy. World J Urol. 2014;32:631-42. 4. Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer. 1981;48: 1487-91. 5. Ohnishi H, Abe M, Hamada H, Yokoyama A, Hirayama T, Ito R, et al. Metastatic renal cell carcinoma presenting as multiple pleural tumours. Respirology. 2005;10: 128-31.Multiple medical and interventional therapies are currently available for correcting persistent atrial fibrillation. One such procedure, hybrid ablation, aims to decrease postablative atrial fibrillation relapse by combining transvenous endocardial ablation with surgical scarring of the epicardium. 1 Recent reports suggest superior outcomes relative to stand-alone transvenous or surgical ablation and an overall complication rate of 4.1% to 11%. 1,2 Reported complications include bleeding, myocardial edema, cardiac tamponade, atrioesophageal fistula, esophage...

Strangulated Intrapericardial Diaphragmatic Hernia after Hybrid Maze Procedure

“…Diaphragmatic defect can be closed primarily with or without a mesh and buttressed with the liver. 7,8 These patients can have delayed postoperative recovery and often need intensive care. It is always desirable to involve senior members of surgical, anaesthetic and ITU teams including cardiologist.…”

Laparoscopic Repair of an Intrapericardial Diaphragmatic Hernia After Convergent Maze Procedure

“…Multiple techniques for the treatment of recurrent AF are now available. The CMP, or hybrid maze, has shown excellent efficacy, with a low rate of adverse events, and it has increased in popularity [1][2][3][4]. We now report the second case of an IDH with small bowel obstruction secondary to the CMP procedure.…”

“…The treatment of IDH is usually primary closure of the hernia without mesh to avoid the possibility of infection or long-term adverse events such as erosion or irritation of the epicardium. In the first reported case of IDH after CMP, the authors closed the defect primarily and buttressed the repair with the liver [3]. In our patient, we opted to close the defect with a fenestrated patch repair with hepatic buttress for multiple reasons.…”

“…Adverse events include death, stroke, phrenic nerve injury, tamponade/effusion and major bleeding requiring sternotomy or reoperation, pneumothorax, temporary phrenic nerve paresis, and postprocedure pericarditis [2]. We report the second case of an intrapericardial diaphragmatic hernia (IDH) after CMP [3]. This rare, potentially life-threatening adverse event may result from the lack or inadequate closure of the transdiaphragmatic port site.…”