🔍 Key Findings

• Laparoscopic PPDH repair was successful in 92% (12/13) of cases, with only one conversion due to CO₂-induced pericardial tamponade
• Low insufflation pressures (3–4 mmHg) were critical to minimize cardiopulmonary compromise while maintaining adequate visualization
• No major (Grade ≥3) complications occurred, with only minor issues (15.5% delayed wound healing, 7.7% seroma)
• All patients survived and had successful long-term outcomes, with imaging confirming repair at 6 months
• Adhesions were the most common intraoperative challenge, especially involving liver or pericardium, occasionally requiring organ resection
• Barbed sutures and endoscopic suturing devices improved efficiency, particularly for intracorporeal closure
• Intraoperative decompression (needle or drain) helped prevent tension pneumopericardium, a key complication risk
• PPDH-SDC grading system aids case selection, with Grades A–B ideal for laparoscopy, C case-dependent, and D–E unsuitable