To analyze the clinical characteristics and surgical safety of diaphragmatic repair in patients undergoing hepatosplenic surgery.

A retrospective cohort study was conducted. A total of 36 patients who underwent diaphragmatic repair during hepatosplenic procedures between January 2019 and June 2025 at Suining Central Hospital and Suining Hospital of Traditional Chinese Medicine. Patients were categorized by cause of injury into disease invasion group (n=17), iatrogenic injury group (n=8), and trauma group (n=11). Patients were categorized by repair method into suture group (n=26) and mesh group (n=10). The clinical characteristics and surgical outcomes of each group were compared.

The trauma group had a higher proportion of emergency surgery (P<0.001) and significantly greater total blood loss [(1100.0±297.5) ml] compared to the disease invasion group[(174.3±77.5) ml] and the iatrogenic injury group [(160.5±64.3) ml] (P<0.001). Mesh repair was used for larger defects [defect width: (2.5±0.69) cm vs. (0.5±0.25) cm; defect area: (11.1±3.33) cm² vs. (2.4±1.36) cm², both P<0.001]. It also required a longer diaphragmatic procedure time [(43.4±6.9) min vs. (22.5±7.1) min, P<0.001], but there was no statistically significant difference in the total operation time (P=0.595). The incidence rates of diaphragm surgery-related complications were compared among the traumatic group, disease invasion group, and iatrogenic injury group [36.4% (4/11), 29.4% (5/17), and 37.5% (3/8)], with no statistically significant difference (P>0.05).The overall complication rate was 33.3% (12/36), all of which were classified as Clavien-Dindo grade I-Ⅲ. Binary logistic regression analysis showed that trauma (OR=1.500, 95% CI 0.330-6.822, P=0.600), surgical approach (laparoscopic vs. open, OR=0.467, 95% CI 0.100-2.173, P=0.331), surgical timing (emergency vs. elective, OR=1.000, 95% CI 0.230-4.349, P=1.000), repair method (mesh vs. suture, OR=0.368, 95% CI 0.081-1.672, P=0.196), and the placement of thoracic drainage (OR=1.667, 95% CI 0.282-9.856, P=0.573) were not independent risk factors for complications.

Diaphragmatic repair in hepatosplenic surgery is generally safe and the complications are controllable. Mesh repair is indicated for larger defects and extends operative time. Although trauma cases are associated with greater blood loss, they do not independently increase the risk of complications. Further studies are needed to identify modifiable risk factors.