Placement of delayed absorbable mesh to prevent herniation following left diaphragm peritonectomy during ovarian cancer cytoreduction.

Background: In the management of advanced ovarian cancer, complex surgery is often necessary to achieve the goal of complete gross resection. Diaphragm resections and intrathoracic procedures are safe and feasible in select patients with advanced ovarian cancer. In our institution, up to 68% of cytoreductive surgery requires diaphragm peritonectomy, and 11% involve intrathoracic cytoreduction (Kahn et al., 2023, Kahn et al., 2024). The left diaphragm is often involved, requiring a peritonectomy. The most common complications include pleural effusion and pneumothorax, although a rare complication of left-sided diaphragmatic herniation has been reported (Ehmann et al., 2021a, Ehmann et al., 2021b). Methods: With this video, our goal is to introduce the novel idea of placing delayed absorbable mesh to reduce the risk of left diaphragmatic herniation following left diaphragm peritonectomy, as well as demonstrate the surgical technique of polyglactin 910 mesh placement during cytoreductive surgery for ovarian cancer. Results: We demonstrate a left diaphragm mesh placement during cytoreductive surgery for ovarian cancer, with the steps as follows: measure the diaphragmatic defect to the peritoneal edges with muscle fibers in-between and cut the mesh along the contour; suture in the right center and left center of mesh from the intraperitoneal side to the diaphragm side and then out to initially anchor to the diaphragm; continue to throw interrupted stitches circumferentially around the woven mesh beginning from the center and extending outwards. Conclusion: Delayed absorbable mesh placement is a feasible technique that may help reduce the risk of left diaphragmatic herniation following peritonectomy in cytoreductive surgery for ovarian cancer.