Laparoscopic repair of Bochdalek diaphragmatic Hernia in Adults

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.

Original languageEnglish
Pages (from-to)65-74
Number of pages10
JournalNorth American Journal of Medical Sciences
Volume8
Issue number2
DOIs
Publication statusPublished - Feb 1 2016

Fingerprint

Diaphragmatic Hernia
Hernia
Precipitating Factors
Mortality
Thoracotomy
PubMed
Laparoscopy
Laparotomy
Vomiting
Length of Stay
Differential Diagnosis
Thorax
Congenital Diaphragmatic Hernias
Morbidity
Recurrence

Keywords

  • Bochdalek hernia (BH)
  • Congential diaphragmatic hernia (CDH)
  • Laparoscopic repair

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Laparoscopic repair of Bochdalek diaphragmatic Hernia in Adults. / Machado, Norman Oneil.

In: North American Journal of Medical Sciences, Vol. 8, No. 2, 01.02.2016, p. 65-74.

Research output: Contribution to journalReview article

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abstract = "Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57{\%} (211/368). Significantly, 6.5{\%} of patients were above 70 years, with 3.5{\%} of these being above 80 years. The majority of the hernias were on the left side (63{\%}), with right-sided hernias and bilateral occurring in 27{\%} and 10{\%}, respectively. Precipitating factors were noted in 24{\%}, with 5.3{\%} of them being pregnant. Congenital anomalies were seen in 11{\%}. The presenting symptoms included abdominal (62{\%}), respiratory (40{\%}), obstructive (vomiting/abdominal distension; 36{\%}), strangulation (26{\%}); 14{\%} of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27{\%}), thoracotomy in 50 (27.7{\%}), combined thoracoabdominal approach in 27 (14.6{\%}), laparoscopy in 23 (12.5{\%}), and thoracoscopic repair in 9 (4.89{\%}). An overall recurrence rate of 1.6{\%} was noted. Among these patients who underwent laparoscopic repair, 82{\%} underwent elective procedure; 66{\%} underwent primary repair, with 61{\%} requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7{\%}. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.",
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