Location
Moultrie, GA
Start Date
7-5-2025 1:00 PM
End Date
7-5-2025 4:00 PM
Description
Background: The vast majority of diaphragmatic hernias in adults are repaired using the laparoscopic approach. The robotic platform is increasingly accepted by foregut surgeons. The most common diaphragmatic hernias are hiatal hernia, but defects may also occur at other sites. Concomitant combined defects are extremely rare and require special techniques including placement of a mesh.
Case report: A 65 y/o female presented with a large symptomatic paraesophageal hernia – her body mass index was 35kg/m2. She complained of gastroesophageal reflux despite using a proton pump inhibitor, regurgitation, epigastric and back pain, shortness of breath, and nocturnal coughing spells. She was counseled regarding diet and weight loss and over the next 3 months she was able to drop 25 pounds, and her symptoms improved somewhat. She underwent robotic assisted paraesophageal hernia repair. During exploration, a sizable sliding hiatal hernia was found, however, the fundus was incarcerated within a 4cm defect just lateral to the left crus. The peritoneum at the hiatal hernia was incised and the hernia contents were reduced, the sack was resected. The esophagus was undermined and dissected free and good intraabdominal length was obtained. Next the contents of the 2nd hernia were gently reduced after the gastrocolic ligament was opened and the short gastric vessels were divided. As the cruroplasty pulled the left crus to the midline, primary repair was impossible, and this defect was closed with coated mesh. A standard floppy Nissen fundoplication was created, and a PEG tube was placed to anchor the stomach in the abdomen.
Results:
She had an uneventful early postoperative course and was discharged on day 2 after an upper GI series showed no leak or stenosis. She did well for a week but then inadvertently pulled the PEG tube out. She underwent exploratory laparoscopy, and the gastric defect was staple closed. Further clinical course was uneventful, and she was well without signs of recurrence after two years.
Discussion: We report successful management of the rare condition of a double diaphragmatic hernia. The second defect needs to be closed tension free with a mesh due to the tension at the repairs to avoid failure and hernia recurrence.
Embargo Period
6-2-2025
Included in
Robotic Assisted Repair of a Concomitant Paraesophageal and Left Diaphragmatic Hernia
Moultrie, GA
Background: The vast majority of diaphragmatic hernias in adults are repaired using the laparoscopic approach. The robotic platform is increasingly accepted by foregut surgeons. The most common diaphragmatic hernias are hiatal hernia, but defects may also occur at other sites. Concomitant combined defects are extremely rare and require special techniques including placement of a mesh.
Case report: A 65 y/o female presented with a large symptomatic paraesophageal hernia – her body mass index was 35kg/m2. She complained of gastroesophageal reflux despite using a proton pump inhibitor, regurgitation, epigastric and back pain, shortness of breath, and nocturnal coughing spells. She was counseled regarding diet and weight loss and over the next 3 months she was able to drop 25 pounds, and her symptoms improved somewhat. She underwent robotic assisted paraesophageal hernia repair. During exploration, a sizable sliding hiatal hernia was found, however, the fundus was incarcerated within a 4cm defect just lateral to the left crus. The peritoneum at the hiatal hernia was incised and the hernia contents were reduced, the sack was resected. The esophagus was undermined and dissected free and good intraabdominal length was obtained. Next the contents of the 2nd hernia were gently reduced after the gastrocolic ligament was opened and the short gastric vessels were divided. As the cruroplasty pulled the left crus to the midline, primary repair was impossible, and this defect was closed with coated mesh. A standard floppy Nissen fundoplication was created, and a PEG tube was placed to anchor the stomach in the abdomen.
Results:
She had an uneventful early postoperative course and was discharged on day 2 after an upper GI series showed no leak or stenosis. She did well for a week but then inadvertently pulled the PEG tube out. She underwent exploratory laparoscopy, and the gastric defect was staple closed. Further clinical course was uneventful, and she was well without signs of recurrence after two years.
Discussion: We report successful management of the rare condition of a double diaphragmatic hernia. The second defect needs to be closed tension free with a mesh due to the tension at the repairs to avoid failure and hernia recurrence.