2017, Number 3-4
Laparoscopic and thoracoscopic uni-portal post-traumatic and chronic diaphragmatic hernia repair. Case report
Pérez PY, Menjivar RÓM, Baley SM, Martínez AMÁ
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Language: Spanish
References: 15
Page: 138-143
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ABSTRACT
Introduction: Diaphragmatic rupture represents 0.8 to 5.8% of all high speed thoraco-abdominal trauma. Most of them occur immediately after trauma but also can appear afterwards in about 4.6% of these cases. At the moment of the injury the gradient of pressure between the abdominal and the thoracic cavity can rise abruptly, causing the splitting of the diaphragm ant the thoracic wall determining an early rupture. Case report: This is a 27 year woman with a cervical spine surgical instrumentation after a high speed car accident with a blunt abdominal trauma 25 years before, a neurogenic bladder and incontinence as a sequelae. She started two years ago prior to hospitalization with gradual mild dyspnoea after average efforts. In a physical examination a decrease in respiratory sounds was found in the right hemithorax. Lab reports showed only an increase in urea derivatives, secondary to chronic renal disease. The abdominal and Thoracic X-ray and a simple CTscan showed the presence of bowel and the right hepatic lobe occupying 40% of the right hemithorax. A thoracoscopy was performed using a 20 mm trocar, inserted in the 6th intercostal space over the mid axilary line. Small intestine and the right hepatic lobe were observed without a hernia sac. The abdominal cavity was accessed through four ports. The diaphragmatic defect was observed of approximately 20 × 15 cm. Traction of the small intestine was performed via laparoscopy with complete reduction of the hernia content. Under direct thoracoscopic vision, the diaphragmatic defect repair was performed via laparoscopy with plication of the diaphragm using extra-corporeal stitches with 2-0 polyester. Then a 16 × 12 cm polypropylene- poliglycolic acid covered with hyaluronic acid bi-layer mesh was placed fixing it with circumferential spiral absorbable tacs. An endopleural tube was placed through the surgical incision and closed with previous sutures placed to close the aponeurotic layers.Conclusion: The laparoscopic simultaneous diaphragmatic hernia repair with thoracoscopy support is a viable option. The thoracoscopic view corroborates the absence of any condition and offers the benefits of minimal access surgery, increasing safety and deceasing risks.REFERENCES