Rajmohan Rammohan, MD, Mandip Joshi, MD, Nisha Dhanabalsamy, MD, Hira Ahmad, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASM, BS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
Introduction: Massive type IV Diaphragmatic hernia is a rare and challenging condition. Laparoscopic management and whether or not to use mesh is still a dilemma. Furthermore standard technique of closing these large crural defects has not been defined clearly.
Objective: To show the operative technique practiced in our clinic for the treatment of massive diaphragmatic hernia.
Methods: We present a case of 37 year old female with the history of severe chest pain for 2 days. CT-scan at outside hospital showed a large diaphragmatic hernia with herniation of abdominal contents with air fluid levels in the left hemithorax. We approached the hernia laparoscopically. Small intestine, stomach, spleen and pancreas were noted to be herniated into the left hemithorax. After reduction of the hernia contents and the sac, large crural defect defined. Pleura was violated during dissection which was suture closed. Crural defect closed from posterior and lateral aspects with 2-0 Barbed unidirectional sutures. Once the defect had been completely closed, a prosthetic patch was placed posterior and secured to the diaphragm with interrupted silk sutures. A floppy Nissen fundoplication was performed over the 32-Fr orogastric tube tube.
Results: The patient tolerated the procedure well with minimal blood loss. Patient postoperatively developed a pneumothorax which was managed conservatively. The patient was discharged home on POD# 2 with normal diet. Two weeks follow up was uneventful.
Conclusion: Laparoscopic approach for Massive diaphragmatic hernia is a safe but challenging option. Using Quill suture and crurafix mesh for these large defects is a feasible technique
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78869
Program Number: V033
Presentation Session: Thursday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo