Minim Invasive Ther Allied Technol. 2019 Jul 12:1-6. doi: 10.1080/13645706.2019.1641523. [Epub ahead of print]
Minimally invasive management of rare giant Bochdalek hernia in adults.
Lirici MM1, Bongarzoni V2, Paolantonio P3, Leggeri T1, Pirillo SP3, Romeo V1.
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Bochdaleck hernia (BH) is a congenital diaphragmatic hernia that presents after birth with respiratory symptoms and needs surgical treatment in the neonatal period. However, there are some rare cases of adult presentation, which require surgery to avoid complications. BHs can be treated through several approaches, including laparoscopy. Laparoscopic treatment of a giant BH was successfully attempted on a woman affected by multiple myeloma, with severe dyspnoea and dysphagia. Preoperative work-up included chest X ray, CT-scan and MRI. The whole stomach, duodenum, the small bowel, the right and transverse colon, most descending colon and the pancreas were herniated into the thorax. The herniated viscera were totally reduced into the abdominal cavity and the large defect of the left diaphragm repaired with a biosynthetic web scaffold especially designed for diaphragmatic reconstruction. Finally, to avoid a compartment syndrome in an abdomen with not enough room for the reduced viscera, an extended right colectomy with extracorporeal anastomosis was carried out through a mini-laparotomy. At seven-month follow-up, the patient is symptomless and control CT scan showed no hernia recurrence. Laparoscopic repair of large symptomatic adult BHs can be performed successfully with significant clinical improvement, even in difficult cases and fragile patients.

Bochdalek hernia; Congenital diaphragmatic hernia; biosynthetic reinforcement; laparoscopic repair

PMID: 31298588 DOI: 10.1080/13645706.2019.1641523