Acquired postoperative diaphragmatic hernias in children

Background: Acquired diaphragmatic hernias are rare surgical pathologies. There is a limited number of the publications on this issue. Postoperative diaphragmatic hernias are complications of prior surgical interventions. The broad spectrum of clinical manifestations ― ranging from asymptomatic cases to intestinal obstruction and respiratory failure ― complicates timely diagnosis and surgical management. Surgical correction of postoperative diaphragmatic hernias, including the choice of surgical approach, requires an individualized strategy. Analysis of the causes of postoperative hernias may help to minimize the risk factors for their development. Aim: To clarify the etiology of postoperative diaphragmatic hernias in children and determine effective methods for their surgical correction. Methods: A retrospective analysis of 14 cases of children with postoperative diaphragmatic hernias was conducted, including assessment of clinical findings, surgical techniques, and postoperative outcomes. Results: Clinical manifestations varied among patients: 35.7% of cases were asymptomatic, 35,7% had intestinal obstruction, and 28.6% respiratory disturbances, including respiratory failure. Diagnosis of diaphragmatic hernias was put in the interval of 2 weeks and 11 years after the initial surgery. Primary causes of postoperative hernias were intraoperative diaphragmatic injury (14.3%) and surgical technical errors during primary procedures (85.7%). Anatomical integrity of the diaphragm was repaired in all patients. Endoscopic approaches were used in 50% of cases, transthoracic diaphragmatic fixation in 50%, and xenopericardial patch repair in 28.6%. The average surgical time was 80 minutes. Early postoperative complications were observed in 3 patients, late complications, including recurrences, were absent. Conclusion: Postoperative diaphragmatic hernias may remain asymptomatic and be diagnosed at varying intervals after surgery. Advanced surgical techniques, such as xenopericardial patch repair and transthoracic fixation of the diaphragm to the ribs, enable reliable diaphragmatic reconstruction with minimal postoperative complications. This study highlights the need for standardized surgical protocols to prevent the development of postoperative diaphragmatic hernias.