A case report of robotic-assisted repair of transabdominal diaphragmatic hernia after sternectomy with omental flap reconstruction

Introduction: Deep sternal wound infection is a serious complication after sternotomy for cardiac surgery. Management can necessitate sternectomy with chest wall reconstruction using a pedicled omental flap, which requires an iatrogenic defect in the diaphragm. This defect can ultimately develop into a larger diaphragmatic hernia and necessitate repair. Case Presentation: Our patient was a 70-year-old female with partial sternectomy with omental flap reconstruction after coronary artery bypass surgery who presented with dyspnea, chest pain, and poor food tolerance. Imaging confirmed a large, diaphragmatic hernia at the site of omental flap and was ultimately repaired primarily using a robotic-assisted approach. Discussion: This case highlights a serious complication related to omental flap reconstruction after sternectomy. Repair of the hernia defect can either be accomplished primarily or with mesh. We pursued primary repair given that there was inadequate adjacent tissue to secure mesh and to preserve the omental flap vascular pedicle. Conclusion: Deep sternal wound infections after cardiac surgery can be managed with sternectomy and a pedicled omental flap. The iatrogenic diaphragm defect created can result in herniation of abdominal contents into the chest. Our case report is the first to describe a robotic approach for repairing an intentionally created diaphragmatic defect.