Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 67-year-old woman with symptoms of partial colon obstruction is described. The patient had a prompt and complete recovery with no evidence of recurrence one year after surgery. The technique, which incorporates the rectus abdominal fascia in the repair, may be suitable for other laparoscopic surgical procedures.
Paraesophageal hernias represent a distinct group of hiatal hernias characterized by their potential for devastating complications. Between 1976 and 1992, a total of 270 surgeries were performed for hiatal hernias at Scripps Clinic, La Jolla, California, of which 33 were pure paraesophageal, without reflux. Starting in September 1991, a laparoscopic technique was used for repair of five out of six attempted cases of paraesophageal hiatal hernias. The closure of the hiatal defect was accomplished with mesh stapled to the edges of the hiatus in front of the esophagus. A gastropexy was added attaching the stomach to the diaphragm. This procedure proved to be technically easy and safe, and resulted in less discomfort and faster recovery of the patients when compared to the open procedure. This laparoscopic repair should be considered as a good alternative to the open techniques for paraesophageal hiatal hernias without reflux.
We recommend the alternative of performing a cholecystostomy with delayed laparoscopic cholecystectomy instead of conversion to open procedure when facing a case of acute cholecystitis not amenable to laparoscopic cholecystectomy.
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