Sara E Holden, MD, Jeffrey A Blatnik, MD. Washington University School of Medicine
This video depicts a 50-year-old female with a symptomatic incarcerated left hemidiaphragmatic hernia. This was caused by a traumatic injury during a prior nephrectomy complicated by an inferior vena cava injury requiring emergent laparotomy and graft reconstruction. Her preoperative symptoms were upper abdominal pain, shoulder pain, early satiety, nausea, and vomiting. Cross-sectional imaging confirmed a left hemidiaphragmatic defect with herniation of the proximal stomach into the hemithorax. The plan was to proceed with minimally invasive reduction of stomach with hernia repair.
Intraoperatively, pneumoperitoneum was established with the Veress needle at the umbilicus. Four robotic trochars were placed at the umbilicus, left subcostal, and right/left lateral abdomen. The robot was docked. Initial inspection demonstrated a large diaphragmatic hernia located just lateral to the left crus, posterior to the left lateral lobe of the liver. The liver and spleen were densely adherent to the diaphragmatic borders of the hernia. A moderate portion of the stomach and omentum were herniated through the defect and incarcerated, requiring meticulous adhesiolysis to fully reduce the contents out of the chest and create appropriate space for the mesh along the diaphragm. The defect measured 4x5cm, and the intraperitoneal space was in continuity with the left pleural space requiring chest tube placement at the completion of the procedure. The hernia defect was closed primarily with interrupted 0-Ethibond sutures and reinforced with a 7x11cm piece of coated polypropylene mesh, covering the defect well in all directions.
The patient was seen 3-weeks post-operatively and recovering well, with improvement in all of her pre-operative symptoms.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94458
Program Number: V408
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop