Which Is the Better Approach for Late-Presenting Congenital Diaphragmatic Hernia: Laparoscopic or Thoracoscopic? A Single Institution's Experience of more than 10 Years

Obata, Satoshi; Souzaki, Ryota; Fukuta, Atsuhisa; Esumi, Genshiro; Nagata, Kouji; Matsuura, Toshiharu; Ieiri, Satoshi; Taguchi, Tomoaki

doi:10.1089/lap.2019.0162

Cited by 9 publications

(24 citation statements)

References 16 publications

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“…Late-onset CDH can be repaired via thoracic or abdominal approaches. While the abdominal approach is more traditional, there has been increased evidence to suggest that thoracic approach can be just as effective [ 10 ]. Our decision to approach this repair through the thorax involved her history of extensive abdominal surgery to avoid the morbidity of potentially prolonged lysis of adhesions and abdominal retroperitoneal exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Our decision to approach this repair through the thorax involved her history of extensive abdominal surgery to avoid the morbidity of potentially prolonged lysis of adhesions and abdominal retroperitoneal exposure. Given the imaging findings that confirmed only the presence of omentum in the hernia sac, the morbidity of an abdominal exploration could be avoided in her case [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Unusual case of delayed congenital diaphragmatic hernia in Loeys-Dietz syndrome: a case report

Lobaton

Chen

Jelin

et al. 2021

Journal of Surgical Case Reports

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Congenital diaphragmatic hernias rarely present after 2 months of age and are typically diagnosed in the perinatal period. Moderate to severe diaphragmatic hernias present with respiratory symptoms, while late-onset hernias have a more varied presentation, depending on the age and content of the hernia. Very rarely, such hernias are found on incidental imaging, in which surgical repair is frequently recommended. A young girl with Loeys-Dietz syndrome and prior abdominal surgeries presents with 1-year history of increasingly severe, intermittent, abdominal and left shoulder pain. Prior imaging incidentally revealed a left diaphragmatic hernia with omentum protruding into the thoracic cavity. This was managed expectantly due to her other medical and surgical issues. Serial imaging revealed that the herniated omentum was increasing in size and symptoms began to develop. An uncomplicated primary thoracoscopic repair was performed. We report the first case of a congenital diaphragmatic hernia in a patient with Loeys-Dietz syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unusual case of delayed congenital diaphragmatic hernia in Loeys-Dietz syndrome: a case report

Lobaton

Chen

Jelin

et al. 2021

Journal of Surgical Case Reports

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“…Late‐presenting CDH has been treated via both thoracoscopic and laparoscopic approaches 6 . In general, the thoracoscopic approach is easier for reduction of herniated organs compared with the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Single incision laparoscopic repair for late‐onset congenital diaphragmatic hernia using oval‐shaped multichannel port device (E•Z ACCESS oval type)—2 months infantile case of Bochdalek hernia

Ieiri

Hino

Irie

et al. 2021

Asian J Endoscop Surgery

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Introduction Late‐onset congenital diaphragmatic hernia constitutes 10%‐36% of congenital diaphragmatic hernias. They qualify for endoscopic treatment including both thoracoscopic and laparoscopic approaches because this type of patient is in relatively stable condition compared with neonatal cases. However, single incision laparoscopic approach has not been reported. We herein report an infantile case of late‐presenting diaphragmatic hernia who underwent single incision laparoscopic repair using an oval‐shaped multichannel port device. Materials and Surgical Technique A 2 month old female infant had sudden onset dyspnea with cyanosis and was diagnosed as having left diaphragmatic hernia (Bochdalek hernia) by chest X‐ray. As her respiratory condition became stable under conservative treatment using combination of decompression of the gastrointestinal tract and mild sedation, we electively planned laparoscopic repair. Preoperative enhanced computed tomography imaging found that herniated organs were stomach, spleen, pancreatic tail, small intestine and right colon. The patient also had an umbilical hernia, so we decided to perform single incision repair through this umbilical hernia. Three trocars were introduced using an oval‐shaped multichannel port device and herniated organs were reduced by gentle manipulation. The defect of the diaphragm was closed by bi‐hand needle driving for upper and lower limb using a stay suture. The umbilical hernia was also repaired. Postoperative course was uneventful and no recurrence was recognized. Discussion Wider trocar separation was achieved using the oval‐shaped device, making the needle driving easier to perform. By using an oval‐shaped multichannel port device and ingenuity of needle driving, single incision repair of infant diaphragmatic hernia was enabled.

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“…The conventional treatment for BH involves placing the herniated organs back in the abdominal cavity and closing the diaphragmatic defect 1,3 . Resection of the hernia sac is usually unnecessary 4,6 .…”

Section: Introductionmentioning

confidence: 99%

“…Even in neonatal cases of BH, a minimally invasive approach has been introduced in several tertiary centers, and the thoracoscopic approach is considered to be preferable 4,7 . Whereas the laparoscopic or thoracoscopic approach has recently become the surgical standard for BH and can be used alternately in late‐presented BH (Late‐BH), efficacy and/or the disadvantage of two approaches are still controversial 1,3,4,6,8–10 . In addition, a few reports have described the combined laparoscopic and thoracoscopic approaches 1,6,8,10 …”

Section: Introductionmentioning

confidence: 99%

Combined laparoscopic and thoracoscopic approaches for Bochdalek hernia with hernia sac in an 8‐years‐old boy: Case report

Tanaka

Mikami

Kato

et al. 2022

Asian J Endoscop Surgery

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Bochdalek hernia (BH) is characterized by a defect of the posterolateral diaphragm and intrathoracic herniation of abdominal organs. The laparoscopic or thoracoscopic approach has recently become the surgical standard. However, studies on combined approaches are limited. An 8-year-old boy diagnosed with left BH was treated using a combined laparoscopic and thoracoscopic approach. On laparoscopy, BH with hernia sac was identified. Spleen, pancreas tail, kidney, and transverse colon had herniated into the left thoracic cavity. After the adhesion between transverse colon and hernia sac was dissected, all abdominal organs were restored to the abdominal cavity. On thoracoscopy, an 8 Â 8 cm hernia orifice defect was identified and closed by suture. The postoperative course was uneventful, with no recurrence. A combined laparoscopic and thoracoscopic approach is safe and effective with a good field of view for left BH with hernia sac in children. To the best of our knowledge, this is the first case with left BH reporting the use of both approaches in a child without conversion.

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Which Is the Better Approach for Late-Presenting Congenital Diaphragmatic Hernia: Laparoscopic or Thoracoscopic? A Single Institution's Experience of more than 10 Years

Cited by 9 publications

References 16 publications

Unusual case of delayed congenital diaphragmatic hernia in Loeys-Dietz syndrome: a case report

Unusual case of delayed congenital diaphragmatic hernia in Loeys-Dietz syndrome: a case report

Single incision laparoscopic repair for late‐onset congenital diaphragmatic hernia using oval‐shaped multichannel port device (E•Z ACCESS oval type)—2 months infantile case of Bochdalek hernia

Combined laparoscopic and thoracoscopic approaches for Bochdalek hernia with hernia sac in an 8‐years‐old boy: Case report

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