Repair of a giant diaphragmatic hernia using the dual approach

Sabah, Salman Al; Haddad, Eliana Al; Vaz, Jonathon D

doi:10.1093/jscr/rjz064

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Right-sided retrocostoxiphoid diaphragmatic hernia causing life-threatening liverincarceration in one patient of our cohort was treated by primary open trans-abdominal hernia repair with mesh augmentation from both sides of the diaphragm by laparotomy and right-sided thoracotomy. Such a 'maximal' surgical thoraco-abdominal approach has already been described in single case reports of congenital diaphragmatic hernia repair in adults and should be reserved for special cases [10,18]. Nevertheless, the role of mesh reinforcement after primary suture of the hernia gaps is still disputed not only in hiatal hernia repair but also in the repair of MLH, and thus a clear evidence does not exist (see our literature review in Table 4) [1,4,14,15].…”

Section: Discussionmentioning

confidence: 96%

Morgagni−Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience

Oppelt

Askevold

Bender

et al. 2020

Hernia

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Purpose Morgagni−Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon's experiences and small case series in the literature. Methods Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome. Results 4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications. Conclusion MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.

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Section: Discussionmentioning

confidence: 96%

Morgagni−Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience

Oppelt

Askevold

Bender

et al. 2020

Hernia

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“…Until March 2016, 31 cases of right-sided BH were reported worldwide, with only 14% being asymptomatic [2,4]. While a left-sided BH has been reported previously in Jordan, there have been no previous reports on right-sided BH [5]. This report presents potentially the world's largest BH and the first right-sided BH with intrathoracic kidney with liver hypoplasty diagnosed in Jordan.…”

Section: Introductionmentioning

confidence: 86%

Conservative approach in adult right-sided Bochdalek hernia with an intrathoracic ectopic kidney

El Sharu,

Alwarawrah,

Alqaisieh

et al. 2023

Exploration of Medicine

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Bochdalek hernia (BH) is a congenital diaphragmatic defect primarily diagnosed in neonates and is usually left-sided. Adult diagnosis, especially of right-sided BH is exceedingly rare and usually presents with symptoms. Till now, only 31 cases have been diagnosed to be right-sided BH along with intrathoracic kidney. This report presents a 26-year-old asymptomatic male who was incidentally diagnosed with a massive right congenital diaphragmatic hernia. Imaging revealed severe abdominal herniation, a right intrathoracic ectopic kidney, and a right liver lobe hypoplasty along with hypertrophied left liver lobe extending down to the pelvic cavity. Several surgeons were consulted, with controversial opinions on whether elective surgery should be performed or withheld. Due to the high risk associated with surgery and the patient’s choice, the surgery was deferred. For almost 18 months, the patient did not report any symptoms or complications. This case highlights the rarity of asymptomatic right-sided BH in adults and the challenges in determining a management approach. Also, it proposes a conservative approach for such patients as a management modality. Most extensive diagrammatic defect reported is estimated to have a neck defect of 10 cm. Most BH cases have been treated surgically and reports on the outcome of a conservative approach are exceedingly rare. In such cases, patient preferences and a thorough risk assessment play vital roles in decision-making regarding conservative versus surgical approaches.

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“…Anterolateral defects are usually simpler to repair than posterolateral defects and can be easily managed with a minimally invasive approach [7] . For giant congenital diaphragmatic hernia, usually a combined thoracic and abdominal approach is needed to overcome the limitations due to inadequate space leading to difficult visualization and mobilization of the herniated viscera [8] . Nowadays, robotic has developed and been applied for these hernia repairs [9] but only few cases of diaphragmatic hernia repair using an only-abdominal approach with robot-assisted technique have been reported, with minimal morbidity and complication.…”

Section: Introductionmentioning

confidence: 99%

Robotic repair of a giant Larrey-type congenital left-sided diaphragmatic hernia in a young woman. A case report and literature review

Nistri

Marinelli

Giacomo

et al. 2022

International Journal of Surgery Case Reports

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Repair of a giant diaphragmatic hernia using the dual approach

Cited by 4 publications

References 7 publications

Morgagni−Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience

Morgagni−Larrey diaphragmatic hernia repair in adult patients: a retrospective single-center experience

Conservative approach in adult right-sided Bochdalek hernia with an intrathoracic ectopic kidney

Robotic repair of a giant Larrey-type congenital left-sided diaphragmatic hernia in a young woman. A case report and literature review

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