Lessons learned in the surgical management of recurrent trichobezoars

Abstract

approach also provides good exposure to the hernia sac and allows safe dissection of potential pericardial and pleural adhesions. 6 The use of mesh has been recommended when the size of the diaphragmatic defect exceeds 20-30 cm 2 . 5,8,9 Recurrence rates are low. In a retrospective review, one recurrence out of 298 cases of Morgagni hernia repair was reported over a mean follow-up between 12 and 85 months. 10 In another study, no recurrences were observed over a follow-up period of 6 months to 10 years among 12 patients. 5 Diaphragmatic hernia in adults is a rare condition. Most of the patients are asymptomatic and are diagnosed incidentally. Others may present with minor chest/epigastric discomfort to major respiratory distress, intestinal obstruction, or may present with strangulation of the herniated contents which could be life threatening. This condition when diagnosed requires urgent surgical repair through open or minimally invasive techniques. Small defects could be closed primarily with nonabsorbable sutures; larger defects require closure and reinforcement with mesh. Outcome after the surgical repair is good with low rates of recurrences.Informed consent was obtained from the patient for this case report.