Combined Laparoscopic Repair of Subxiphoid and Diaphragmatic Hernias in a Heart Transplant Recipient

Arnab Majumder, MD, Heidi Miller, MD, Yuri W Novitsky, MD, FACS. Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH

Briefly this is a video demonstrating combined laparoscopic closure of a subxiphoid along with multiple diaphragmatic hernias in a 35 year old female with idiopathic cardiomyopathy. She has had a history of LVAD placement and removal following a subsequent heart transplant. She presented with upper abdominal pain and bulging. She was noted to have an epigastric hernia without obstructive symptoms. Intraoperatively she was found to have three diaphragmatic defects with incarcerated omentum. 

The video shows multiple combined techniques including 'shoelace' closure of a ventral defect as well as intracorporeal closure of diaphragmatic defects in the vicinity of a transplanted heart. We address the challenges of closure of a complex ventral and diaphragmatic defect along with mesh placement and fixation using a combination of absorable fasteners, transfascial sutures as well as fibrin sealant. 

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