Double Trouble – Laparoscopic repair of traumatic diaphragmatic and incisional hernia

Tejal Pandya, MD, Praneetha Narahari, MD

Community Regional Medical Center/UCSF Fresno MEP, Fresno, CA

Introduction

Laparoscopy is used in the repair of acute traumatic diaphragmatic tears. There is paucity of literature for use in diaphragmatic hernia in adults. We report a case where recurrent traumatic diaphragmatic hernia and abdominal incisional hernia were repaired with mesh in one session with laparoscopy.

Case Summary

49 yr old sustained a traumatic diaphragmatic hernia from MVA. Emergent laparotomy with primary repair was performed. She is obese and a smoker Patient represented with dyspnea, cough, chest pain and painful bulge in the abdominal incision. CT scan revealed a recurrent left sided diaphragmatic hernia with splenic flexure in the chest and an incisional hernia from prior laparotomy.

The recurrent diaphragmatic hernia in the left central diaphragm was repaired with generous overlap of mesh with staples and sutures. Incisional hernia also repaired with mesh using transfascial sutures/staples. Proceed mesh(synthetic polypropylene/bioresorbable ORC layer) was used Patient recovered well and was discharged post op day 3. A CT scan done at one week for constipation in the ER revealed an intact repair with seroma at both sites.

CONCLUSION

With advancing skills laparoscopy can be applied to a variety of disease processes. In the index case both the symptomatic hernia- incisional and recurrent diaphragmatic- were repaired with mesh in one session. Laparoscopy offers excellent results in incisional and paraesophageal hernia repairs. As a corollary we feel it is safe and feasible in the repair of traumatic diaghragmatic hernia. Long term results are not known but the laparoscopic approach is feasible, safe and offers quicker recovery and shorter stay.


Session: Poster Presentation

Program Number: P280

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