Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report

Tokumoto, Noriaki; Tanabe, Kazuaki; Yamamoto, Hideki; Suzuki, Takahisa; Miyata, Yoshihiro; Ohdan, Hideki

doi:10.1186/1752-1947-4-366

Cited by 30 publications

(43 citation statements)

References 18 publications

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“…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.…”

Section: Discussionmentioning

confidence: 89%

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

et al. 2018

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Bochdalek hernia (BH) is a major malformation that consists of a postero-lateral diaphragmatic defect through which abdominal contents can migrate into the thorax. It is most commonly a neonatal pathology associated with significant morbidity and mortality. Rarely, this type of congenital diaphragmatic hernia (CDH) presents later in life, some even in adulthood. Indications for surgery are not clear even though the majority of authors, being aware of the possible severe complications, recommend surgical correction in all cases. Many surgical approaches have been tried for this pathology, both open (laparotomic or thoracotomic) and minimally invasive (laparoscopic or thoracoscopic). We report a case of a late-onset BH corrected with a robot-assisted thoracoscopic procedure. The use of robotic technology for CDH has never been described to date.

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Section: Discussionmentioning

confidence: 89%

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

et al. 2018

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“…A classification system based on time of diaphragmatic herniation in life and respiratory development has been proposed 12. Adults tend to present with vague symptoms, including recurrent chronic abdominal pain, nausea/vomiting, constipation, chest pain or shortness of breath 4 13–17. Additional morbidity can include reduced exercise capacity with chronic lung disease, reduced intra-abdominal space complicating future surgery, stunted psychomotor development, stunted growth, nutritional disorders and gastro-oesophageal reflux disease.…”

Section: Discussionmentioning

confidence: 99%

“…There are also numerous cases in the literature describing the primary VATS approach, especially in adults 4 15 41 43–46. Earliest published reports with VATS in children for diaphragmatic hernia repair date back to 1995 but very few exist for the adult population 47–49.…”

Section: Discussionmentioning

confidence: 99%

Massive symptomatic right-sided Bochdalek hernia in an adult man

et al. 2016

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A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.

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“…The size of the mesh which is used to bridge the defect varies according to the defect size. Laparoscopic and thoracoscopic approaches have been used, even in recurrent hernias [7,8]. Flaps with the use of muscle or fascia and biomaterial patch repairs have as well been performed.…”

Section: Discussionmentioning

confidence: 99%

An Adult Recurrent Diaphragmatic Hernia with a Near Complete Defect: A Rare Scenario

Sathyanarayana

Rao²,

Shivaprasada³

2012

JCDR

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A diaphragmatic hernia is usually seen in childhood and it is rare in adults. We are reporting a case of a 73 years old male who presented with pain and distension of the abdomen, breathlessness and constipation. He was operated 10 years back for a diaphragmatic hernia, during which a splenectomy, omentectomy and a mesh repair were done. X-rays and CT scans of the chest and the abdomen showed a recurrent diaphragmatic hernia on the left side. Laparotomy and left sided thoracotomy was done. The contents being the small bowel and the colon, they were reduced. The left hemi-diaphragm was completely absent, except for an anterior thin rim of tissue. A short ischaemic jejunal segment was resected. A dual mesh was used to reconstruct the left hemi-diaphragm in a contaminated field and it was fixed to the intact rim and to the other available tissues around the defect. The post-operative chest X-rays showed the mesh to be in place. The patient had an uneventful recovery. No signs of recurrence were found during 2 years of followup. Adult diaphragmatic hernias, once they are diagnosed, are managed surgically to prevent complications. Difficult scenarios may be encountered, for which the surgical strategy should be individualized and the immediate postoperative complications should be dealt appropriately. InTRoduCTIonA diaphragmatic hernia is a condition which is commonly diagnosed and treated in the neonatal period. This condition may rarely be undiagnosed at birth and it may present with symptoms in adulthood. The adult diaphragmatic hernias are usually asymptomatic and they are diagnosed incidentally when patients are being investigated for non-specific symptoms. Most of the complications are related to visceral incarceration and hence, an early surgical management becomes mandatory. The defect in the diaphragm is approximated with interrupted sutures if it is small and it is covered with a prosthetic mesh patch if it is large sized [1].The use of a mesh in a contaminated field has a considerable risk. A complete absence or a near complete defect in a diaphragmatic hernia is a rare presentation and operating in a recurrent situation with minimal information of the previous surgery makes the surgical treatment a challenging task. The fixation of a suitable mesh in a tension free manner to the available minimal surrounding structures, creates a rare but a complex scenario. The reduction of large hernias may lead to untoward sequelae in the immediate postoperative period, which has to be borne in mind. CASe RePoRTWe are reporting a case of 73 years old male who presented to us in the surgical emergency ward with distension of the abdomen and colicky pain of 4 days duration and breathlessness and constipation of 3 days duration. On examination, he was found to have tachypnoea, normal haemodynamics and distension of the abdomen. There were no signs of peritonitis. The bowel sounds were sluggish. The left hemithorax was not expanding as compared to the right one and the breath sounds were diminished on the left side...

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Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report

Cited by 30 publications

References 18 publications

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

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

Massive symptomatic right-sided Bochdalek hernia in an adult man

An Adult Recurrent Diaphragmatic Hernia with a Near Complete Defect: A Rare Scenario

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