Laparoscopic repair of left paraduodenal hernia: Report of two cases and review of the literature

Abstract

Internal hernia is the cause of only 1% of intestinal obstructions, and left paraduodenal hernias (PDH) comprise about 50% of these cases. As the presentation of PDH is varied, diagnosis is often delayed. Here, we report two patients with left PDH presenting in a subacute manner and diagnosed rapidly with the help of a CT scan. Both underwent successful laparoscopic repair; one patient had closure of the defect, and the other required excision of the sac prior to the closure. We review 21 cases of left PDH treated laparoscopically that were previously reported in the literature, including 14 from Asian countries.

A Cause of Acute Abdomen that Should not be Neglected: Left Paraduodenal Hernia

“…Small intestinal loops enter into a cavity called fossa of Landzert, which is localized between the mesocolon and posterior abdominal wall, lateral to 4 th part of the duodenum and posterior to the inferior mesenteric vein, forming this herniation (7). Clinical manifestations of LPH has a broad spectrum which may vary between mild nonspecific abdominal pains to signs of severe peritonitis (2,6,8). Although nausea, vomiting, abdominal pain, constipation and distension may not be present in all patients, they are major symptoms in many patients, as they were in our patient.…”

“…Barium imaging techniques may be beneficial in diagnosis (4). Laparoscopic or open surgical methods may be preferred in the treatment of LPH (2,8). Primary sewing of entrance of the sac after the intestinal loops stuck in the hernial sac are reduced is the most commonly recommended and performed method and the method also we preferred.…”

“…Primary sewing of entrance of the sac after the intestinal loops stuck in the hernial sac are reduced is the most commonly recommended and performed method and the method also we preferred. Absorbable or non-absorbable sutures may be used (8). Leaving entrance of the hernial sac as dilated may also be considered as a treatment but it is rarely preferred (8,11).…”

“…Absorbable or non-absorbable sutures may be used (8). Leaving entrance of the hernial sac as dilated may also be considered as a treatment but it is rarely preferred (8,11). There are surgeons who recommend complete excision of the hernial sac but its application is generally avoided, as it may cause mesocolic or vascular injury (8,11).…”

“…Leaving entrance of the hernial sac as dilated may also be considered as a treatment but it is rarely preferred (8,11). There are surgeons who recommend complete excision of the hernial sac but its application is generally avoided, as it may cause mesocolic or vascular injury (8,11). In the presence of necrosis, that is usually observed in advanced stage, resection may be required due to increased risk of mortality and morbidity (6,12).…”