Laparoscopic Repair of a Larger Diaphragmatic Hernia Mimicking a Type II Paraesophageal Hernia

Marcelo W Hinojosa, MD, Maximiliano Loviscek, MD, Brant K Oelschlager, MD. University of Washington

 

Introduction: Diaphragmatic hernia in adults is rare. We describe the laparoscopic repair of a large diaphragmatic hernia mimicking a type II paraesophageal hernia in a 63 year-old female with longstanding gastroesophageal reflux, worsening heartburn, regurgitation, postprandial abdominal pain and early satiety.

Methods: Preoperative work-up included upper gastrointestinal series, 24-hour pH monitoring, and esophageal manometry. In the operating room, 4 abdominal trocars and a Nathanson liver retractor were placed. The transverse colon and the fundus of the stomach were reduced. The short gastric vessels and attachments from the hernia to the stomach were taken down. The gastrohepatic ligament was incised and the right phrenoesophageal membrane was entered. An intact hiatus and a left-sided diaphragmatic defect were noted. The diaphragmatic defect and the hiatus were then closed primarily. An extracellular surgical mesh reinforcement was placed and a Nissen fundoplication was performed.

Results: The operative time was 180 minutes and there were no intraoperative complications. The patient was started on a clear diet on postoperative day 0 and was discharged home on postoperative day 1. There were no postoperative complications.

Conclusion: Type II paraesophageal and diaphragmatic hernias can present similarly.  In our experience, laparoscopic diaphragmatic hernia repair is a safe and effective technique with acceptable morbidity.


Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V119

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