Laparoscopic Repair of a Large Pericardial Hernia

Chan W Park, MD, Aurora D Pryor, MD. Duke University

Introduction:
Pericardial hernias are rare but known iatrogenic complications following pericardial windows performed for various indications. To date, only a handful of case reports are available in the literature, and surgical experience is also extremely limited. We present a video depicting the technique for the laparoscopic repair of an 8cm by 5cm pericardial hernia defect.

Method:
A standard 4-port laparoscopic approach for the repair of a diaphragmatic hernia was undertaken in a 49-year old female with worsening dysphagia, epigastric discomfort, and a previous surgical history significant for pericardial window performed for an acute pericardial effusion several years prior. Greater omentum, left lobe of liver, and portions of stomach, small, and large intestines were identified within the pericardium and carefully reduced back into the abdomen. Minimal bipolar electrosurgical dissection and sharp adhesiolysis was performed to circumferentially free up the edges of the pericardial defect, and a 19cm by 15cm Gore-tex® permanent mesh was utilized to repair the hernia. The mesh was secured into position with permanent sutures (placed laparoscopically and trans-fascially) and spiral tacks.

Results:
Satisfactory coverage of the pericardial defect with generous mesh overlap extending beyond the hernia edges was achieved with a minimally invasive approach. The patient’s post-operatively recovery was complicated by bilateral lung consolidation and atelectasis, but she was managed with conservative medical treatment and discharged on post-operative day 4.

Conclusion:
Pericardial hernias are rare, and surgical experience in managing this condition is limited. This video presents a minimally invasive surgical approach to repairing a large pericardial hernia.