Bochdalek hernias in the adult population: a systematic review of the literature

Abstract

Background: Bochdalek hernia (BH) is characterized by the protrusion of viscera into thorax through the posterolateral section of the diaphragm. The aim of this study was to systematically review current literature concerning Bochdalek hernias in adults and elucidate their clinical characteristics and preferable treatment approach. Methods: A search of PubMed and Cochrane bibliographical databases for studies regarding BHs was conducted (last search: 31st March 2021). Results: Predefined inclusion criteria were met by 173 articles and concerned collectively 192 patients (50.5% males) with a mean age of 45.41 AE 20.26 years. Abdominal pain (62.0%) and pulmonary symptoms (41.1%) were the predominant symptomatology of included cases. BHs protruded mainly through the left side of the diaphragm (70.7%), with large intestine (42.7%) and stomach (37.1%) being the most commonly herniated abdominal organs. Most patients (53.8%) underwent an open surgical approach, while abdominal approach was preferred (64.8%). to the thoracic one. Thirty-day postoperative complication were encountered at 21.5% of patients, while 30-day mortality reached 4.4%. Conclusion: BH is an extremely rare type of congenital diaphragmatic hernia. It rarely concerns adults, and it manifests with vague gastrointestinal or pulmonary symptoms. Surgical approach is the preferred method for their management with open procedures being preferable at emergency cases, while minimal invasive approach necessitates experienced centers. Further research is needed in order to clarify their true incidence and optimal therapeutic strategy.

Incidental discovery of a giant congenital diaphragmatic hernia in an adult: A case report and literature review

“…The most common type of CHD is the Bochdalek hernia, a posterolateral defect in the diaphragm. The diagnosis in adults is rare, with less than 200 cases reported [ 19 , 20 ]. Common symptoms of adulthood Bochdalek hernia include shortness of breath, food intolerance, gastroesophageal reflux, nausea, vomiting, abdominal cramping, distension, and abdominal pain [ 20 ].…”

“…They are particularly useful in managing incarcerated or strangulated hernias. The laparoscopic approach involves strategic patient positioning to manage complications like pneumothorax during the procedure [ 19 , 21 , 23 ]. The choice of materials for repair—whether absorbable, non-absorbable, or composite mesh—depends on the specific needs of the repair and the surgeon's preference.…”

Hiatal Hernia to Bochdalek: A Case Report

“…A study by Katsaros et al [ 4 ] emphasizes the importance of prompt surgical intervention in patients diagnosed with Bochdalek hernia to avoid potentially life-threatening complications. These hernias can escape detection in adults and become surgical emergencies when abdominal organs are strangled, leading to serious medical conditions such as intestinal obstruction or gastric volvulus.…”

Response to ‘Re: Bochdalek hernias in adult population: a systematic review of the literature’

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We would like to thank Koliakos et al for their precise remarks on our article entitled 'Bochdalek hernias in the adult population: a systematic review of the literature'. 1,2 Their comments highlight the importance of current advancements on surgical technique, available technology, and their undoubtable impact on the management of Bochdalek hernias (BHs).Stratifying collected data from our systematic review into two categories, based on publication date (pre-vs. post-2012), reveals current trends on surgical management of BHs and their postoperative outcomes, as shown in Table 1. Minimally invasive techniques were preferred in the majority of cases published after 2012 (53.5%), in contrast to the previous period, where open surgical approach was mainly utilized (62.2%).

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“…We would like to thank Koliakos et al for their precise remarks on our article entitled 'Bochdalek hernias in the adult population: a systematic review of the literature'. 1,2 Their comments highlight the importance of current advancements on surgical technique, available technology, and their undoubtable impact on the management of Bochdalek hernias (BHs).…”