Advantages of Video-assisted Thoracoscopic Surgery for Adult Congenital Hernia with Severe Adhesion: Report of Two Cases

Abstract

Adults who have undergone surgical repair of congenital diaphragmatic hernia have a prolonged illness. They usually have severe adhesions around the intrathoracic hernial sac; therefore, the adhesion itself as well as misidentification of the hernial defect can make surgical repair difficult, even in open surgery. Here, we present the successful video-assisted thoracoscopic surgical repairs of Bochdalek and Morgagni hernias in patients with severe adhesions of the hernial sac (peritoneum) to the parietal pleura lying over the thoracic wall and diaphragm. An 18-year-old woman with a Bochdalek hernia and a 28-year-old woman with a Morgagni hernia underwent thoracoscopic division of severe adhesions, proper minithoracotomy, and precise repairs of diaphragmatic defects. Postoperative courses of both patients were uneventful with no signs of recurrence of the hernia. Thus, we recommend the thoracoscopic approach as the first choice over an open or laparoscopic approach in the management of adult patients with Bochdalek or Morgagni hernias and severe adhesion.

Empleo de toxina botulínica en pared abdominal como tratamiento previo a la reparación quirúrgica de una hernia de Morgagni gigante

“…Entre las pruebas de imagen, el tac con contraste oral es la técnica idónea para obtener la máxima información [8][9][10] . Con esta técnica, acompañada de la maniobra de Valsalva, podremos calcular volúmenes y presiones intraabdominales, así como la distensibilidad de la musculatura abdominal, con el fin de evitar una elevación excesiva de la presión intracavitaria tras la intervención quirúrgica y prevenir un posible síndrome compartimental.…”

Robot-assisted thoracoscopic repair of a late-onset Bochdalek hernia: a case report

“…In English literature only 8 adult cases using the thoracoscopic approach have been reported. [9][10][11][12][13][14][15] In our case, we had the chance to use the robot-assistance to conventional thoracoscopy which has never been described to date. The advantages of such assistance are attributed to wristed instrumentation with 7 degrees of freedom, a better ergonomics of the surgeon and 3D visualization.…”

Morgagni hernia: Report of two cases and brief review of anatomy and literature

“…[16] Limited series advocate thoracoscopic approach in Morgagni hernia patients with severe intrathoracic adhesions due to chronic bowel herniation. [17] Currently there is no consensus on the optimal approach to repairing Morgagni hernias, and each case should be considered on an individual basis.…”