David A Santos, MD, Nina N Bowman, DO, Clifford C Eke, MD, FACS. Kaiser Permanente Southern California Fontana/Ontario Medical Center.
Bochdalek hernias are rare entities in adults and usually present as bowel obstruction. Asymptomatic hernias, as diagnosed on computed tomography, have an incidence of 0.17% in the general population. The optimal repair of a symptomatic hernia is unknown, however primary suture repair and mesh repair with biologic and synthetic mesh have all been described. Given the rarity of symptomatic hernias, long term data on recurrent Bochdalek hernias is scarce.
The patient presented is a 22 year old man who presented with symptoms of large bowel obstruction. Computed tomography was utilized in diagnosing incarcerated colon in the thoracic cavity. Techniques for positioning and exposure similar to laparoscopic splenectomy were utilized. Advanced laparoscopic techniques barrowed from hiatal hernia repair and ventral hernia repair were adapted. Solutions for awkward suturing angles are also presented.
Successful repair of the Bochdalek hernia was performed laparoscopically. Minimal postoperative pain was experienced by the patient, and rapid return to full physical activity was seen. Long term follow up for the patient is in progress.
The optimal repair of Bochdalek hernias is unknown, however existing surgical techniques can be adapted for successful laparoscopic repair. The known benefits of minimal access surgery, minimal pain and fast recovery, are applicable to posterior diaphragm repair.