Laparoscopic management of paraduodenal hernias: mesh and mesh-less repairs. A report of four cases

Abstract

The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development. Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents. A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias. It carries all of the benefits of minimal access surgery, while providing a sound repair.

Paraduodenal Hernia: A Rare Case Report

“…6 With the total number of reported cases in literature being less than 500 7 , the natural history is to remain asymptomatic during the lifetime of a person. 8 However, there is a 50 % lifetime risk of obstruction when a paraduodenal hernia is present. Clinically, most patients present with recurrent episodes of abdominal pain, often progressing to partial or complete intestinal obstruction.…”

Left Paraduodenal Hernia: Case Report and Literature Review

“…The true incidences of these hernias are difficult to establish as many cases are either completely asymptomatic or misdiagnosed as functional gastrointestinal abnormalities. Only around 50% of paraduodenal hernias for example present with SBO or bowel strangulation 3 . In large autopsy series the prevalence of PDH has been reported Between 0.02 and 0.2% however it might be higher as suggested by a recent retrospective review of 294upper gastrointestinal X-ray series that revealed PDH in 2% of the reviewed cases 4,5 .…”

“…75% of these hernias are left-sided and due to failed embryological development. The reported lifetime risk of obstruction and bowel strangulation is around 50% with a mortality of 20% and higher 2,3 . The diagnosis of PDH is difficult as symptoms are often nonspecific and many clinicians are unfamiliar with this rare condition.…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…Even though all of the studies are of low LE, the potential role of laparoscopy in the diagnosis seems to be demonstrated in them and would, at times, prevent unnecessary laparotomies [298][299][300][301][302][303][304][305][306][307][308][309][310][311][312][313][314][315][316][317].…”