Reduced port laparoscopic repair of Bochdalek hernia in an adult: A first report

Abstract

Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic hernia repaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.

Successful laparoscopic repair of an incarcerated Bochdalek hernia associated with increased intra-abdominal pressure during use of blow gun: A case report

“…However, a case treated as a pulmonary infection approximately for 1 year because of chest radiography findings revealing consolidated areas in the left basal lung segments has been reported [4] . CT scans are the only way to directly visualize the focal defect in the diaphragm, and the presence of a soft tissue contour in the chest CT, in addition to opaque, filled, dilated bowel segments above the diaphragm, establishes a definitive diagnosis [7] .…”

Laparoscopic repair of a Bochdalek hernia in an adult woman

“…Many BH are identified by gas-filled bowel loops or a soft tissue mass above the dome of the diaphragm ( 1 ). Chest CT is necessary to make an accurate diagnosis because it can show a focal defect in the diaphragm, the herniated contents, and a thickening of the diaphragm ( 8 ), ,, findings that were present in our patient. CXR of the patient showed bronchopneumonia and left pleural effusion.…”

“…BH is a congenital anomaly in neonatal and postnatal patients that occurs in about 1 in 2200–12 500 live births, but it is rare in adults ( 2 ). BH has a female predominance ( 1 , 8 ), and our patient was a woman. Most hernias (80%–90%) are found on the left side ( 2 ), which was the case for our patient.…”

“…Both laparoscopic and thoracoscopic repairs of BH have been reported ( 2 ). There have been three reports of BH presenting in adulthood repaired laparoscopically ( 8 ). The procedure of choice depends on the surgeon's experience ( 3 ).…”

“…The fluid might be accumulated and fill the pleural space after removal of the herniated viscera because, if the ipsilateral lung does not fully expand or there is no compensatory mediastinal shift, the air in the cavity is absorbed ( 9 ). Minimally invasive techniques may result in reduced morbidity and improve the ease of hernia reduction, hemostasis, and adhesiolysis ( 5 , 8 ). These techniques also offer the advantages of a shorter hospital stay, shorter recovery time, faster return to normal diet, faster return to normal activity, and better cosmesis ( 10 ).…”