Yonghae Baik, MD, Matthew Mullen, MD, Hunter Mehaffey, Peter Hallowell, MD, Bruce Schirmer, MD. University of Virginia Health System
Introduction: Large symptomatic diaphragmatic hernias can be technically challenging procedures in patients who often have significant medical problems. We reviewed our series of patients who underwent repair of Type III or Type IV symptomatic diaphragmatic hernias. We hypothesized that using a laparoscopic approach could produce low morbidity and mortality.
Methods: We retrospectively reviewed the electronic medical records at a single academic medical center dating from October 2009 through March 2016. A total of 80 patients with Type III (n=72) or IV (n=8) diaphragmatic hernia were surgically treated by two attending surgeons, with 75 being treated using a laparoscopic approach. Data gathered included operative details, patient age, comorbidities present, postoperative length of stay, complications, and recurrence rates.
Results: Most patients were female (n=63). The mean age was 64.6 years. 45 patients were ASA class II and 35 were class III. Eight patients had type IV diaphragmatic hernias, with all having at least colon in addition to stomach herniated into the mediastinum. Seventy-five elective and five emergent procedures were performed. A laparoscopic approach was used in 78 of 80 patients, and three patients were converted to open surgery intraoperatively. Mean operative time was 166 minutes (range 60 to 330 min). Length of stay was 2.6 + 2.3 days. There were 12 (15%) post-operative complications of Grade II or higher, with one reoperation for bleeding and one reoperation for dysphagia at two months postop. There was no mortality. Average duration of follow-up was 20 months (range 1-77 months). Multivariate analysis showed that an open approach and emergency surgery were independent risk factors for developing postoperative complications (p=0.04, p=0.03). Diagnosed recurrence rate for diaphragmatic hernia was 7 cases or 8.8%. Three cases (3.75%) were recurrent type III diaphragmatic hernias which required reoperation. Multivariate analysis showed that postoperative complications did not correlate with the development of a recurrent hernia.
Conclusion: Type III and IV diaphragmatic hernias can be successfully treated with relatively low morbidity and recurrence rates using a laparoscopic approach. Emergency surgery and an open approach appear to increase the potential for postoperative complications. However, postoperative complications do not seem to be important in determining hernia recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79813
Program Number: P033
Presentation Session: Poster (Non CME)
Presentation Type: Poster