Laparoscopic management of symptomatic congenital diaphragmatic hernia in the adult

Jesse L Madden, MD, Austin M Hill, MD, Samuel J O’Brien, Robert C Wrona, MD, Robert E Glasgow, MD

University of Utah

Background
Currently, there is a paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia (CDH) in the adult. This study aims to describe our surgical technique and outcomes in adult patients undergoing laparoscopic symptomatic CDH repair, including hernias of the foramen of Morgagni and Bochdalek.
Methods
This was a retrospective review of all adult patients from 2003-2012 who underwent a laparoscopic congenital diaphragmatic hernia repair at our institution. All patients underwent a similar laparoscopic approach including: reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (if possible) and mesh reinforcement with permanent mesh as indicated.
Results
The study population consisted of 10 consecutive patients; 9 patients had a Morgagni hernia and 1 had a giant right-sided Bochdalek hernia. Patients presented with a variety of symptoms attributed to the hernia including: pain 80%(8), shortness of breath 60%(6) and obstruction symptoms 30%(3). Other complaints included: nausea 20%(2), reflux 20%(2), vomiting 10%(1), early satiety 10%(1), palpitations 10%(1), and a gurgling sensation in the chest 10%(1). Primary repair was possible in all patients with Morgagni hernias. Mesh reinforcement was used in 4 of 9 patients with Morgagni hernias and mesh replacement used in the one giant Bochdalek hernia. Average length of stay was 2.3 days (range 0.5-5.5 days). At a median follow-up of 10.9 months, all symptoms attributed to the hernia had resolved. No clinical recurrences were identified. One patient had a sinus infection post-op which resolved with antibiotics, otherwise there were no immediate nor longterm complications.
Conclusions
Adults with symptomatic CDH of the foramen of Morgagni and Bochdalek should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect, with or without mesh reinforcement can be performed safely and effectively.


Session: Poster Presentation

Program Number: P300

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