What type of surgeon repairs a diaphragmatic hernia?

Diaphragmatic Hernia Repair: Surgical Specialty Selection

Diaphragmatic hernias can be repaired by either general surgeons or thoracic surgeons, with the choice depending primarily on the surgeon's experience and the specific characteristics of the hernia. 1

Surgical Approach by Hernia Type and Patient Condition

• For complicated diaphragmatic hernias in unstable patients or those with signs of strangulation/perforation, the abdominal approach (laparotomy) is recommended, typically performed by a general surgeon 2
• In stable patients with complicated diaphragmatic hernias, a minimally invasive approach (laparoscopic) is suggested, which can be performed by either general or thoracic surgeons 2
• For chronic hernias with viscero-pleural adhesions, a thoracic approach (thoracotomy or thoracoscopy) may be preferred, which would typically involve a thoracic surgeon 2
• In some complex cases, a combined thoraco-abdominal approach may be necessary, requiring collaboration between surgical specialties 2

Comparison of Surgical Outcomes by Specialty

• Research shows no significant difference in mortality, major morbidity, or readmission rates between thoracic and general surgeons performing hiatal hernia repairs 1
• Surgical approach and patient factors have more influence on outcomes than surgeon specialty 1
• General surgeons more commonly use laparoscopic approaches (95.0% vs 82.6% for thoracic surgeons) 1
• Thoracic surgeons more frequently use thoracic approaches (8.5% vs 0.6% for general surgeons) 1

Factors Influencing Surgical Approach Selection

• The chronicity of the condition is a primary factor in determining the best surgical approach 2
• Surgeon preferences and skills significantly influence the approach chosen 2
• Local resources and available expertise play an important role in surgical specialty selection 2
• Right-sided diaphragmatic hernias may require specialized approaches due to the presence of the liver, potentially necessitating thoracic surgical expertise 2

Modern Trends in Diaphragmatic Hernia Repair

• Minimally invasive approaches (laparoscopic or thoracoscopic) have become the most commonly used techniques for managing complicated diaphragmatic hernias 2
• Laparoscopic repair offers shorter hospital stays compared to open surgery (median 6 days vs 16 days) 3
• Robotic surgery for diaphragmatic hernia repair is emerging but currently has limited data 2
• The proportion of outpatient cases performed by general surgeons has increased significantly (from 28.1% to 46.4% between 2012-2019) 1

Common Pitfalls and Considerations

• Surgeon specialty is less important than surgical approach and patient factors in determining outcomes 1
• Factors that more strongly influence outcomes include surgical approach, inpatient vs outpatient status, ASA class, and functional status 1
• For large defects (>8 cm or >20 cm²), mesh reinforcement is recommended regardless of surgeon specialty 2, 4
• Tackers should be avoided near the pericardium due to risk of cardiac complications, regardless of which specialist performs the surgery 2