Iatrogenic Diaphragm Injury Repaired with Mesh Suture.

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Surgical Endoscopy

Abstract

Introduction: Mesh suture is a newer innovation has been used in many contexts. It was approved by the FDA in 2022, designed as a mid-weight polypropylene network of suture. This case demonstrates the use of mesh suture for diaphragm defect closure.

Case Report: This is a 63-year-old female with a past medical history of polysubstance abuse, hepatitis C, COPD who presented with xanthogranulomatous pyelonephritis secondary to a large left staghorn calculus (Fig. 1). This was causing a retroperitoneal abscess and was adherent to the diaphragm as well. She was taken to the operating room for a combination case with urology, colorectal surgery, and general surgery. The left colon at the splenic flexure was found adherent to Gerota’s fascia. The abscess was also causing adherence to the left psoas muscle as well as the diaphragm. The left colon was mobilized off the kidney and did not require any resection. The general surgery team then was called into the operating room, and the kidney was removed from its superior attachments close to the diaphragm. There was a 10 cm defect in the diaphragm after this resection and the left lung was visualized. This was closed in a running fashion with a #2 mesh suture with minimal tension. The midline fascia was then also closed with a #2 mesh suture. She progressed well post-operatively with diaphragm repair remaining intact (Fig. 2) and was discharged on post-operative day 14 to rehab on prolonged IV antibiotics.

Conclusion: Mesh suture has been used on the diaphragm in various contexts such as for hiatal hernia repairs and diaphragm defects as shown here.

Volume

39

Issue

Suppl 1

First Page

S150

Last Page

S150

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

DOI

10.1007/s00464-025-11690-9

ISSN

1432-2218

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