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. 2019:60:164-167.
doi: 10.1016/j.ijscr.2019.06.022. Epub 2019 Jun 17.

Hand-assisted laparoscopic surgery for Bochdalek hernia in an adult patient with a history of laparotomy: A case report

Shogo Fukutomi  1 , Shoichirou Arai  2 , Masahiro Fujisaki  2 , Kazuya Naritomi  2 , Masahiro Kawabata  2 , Masae Mano  2
Affiliations

Hand-assisted laparoscopic surgery for Bochdalek hernia in an adult patient with a history of laparotomy: A case report

Shogo Fukutomi et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Bochdalek hernia (BH) is a congenital diaphragmatic hernia that generally occurs in infants and is rarely seen in adults. Surgical repair of BH is recommended, but the approach for repairing BH should be selected carefully in individual cases. It is well known that hand-assisted laparoscopic surgery (HALS) has the advantage of preserving tactile sensation compared with standard laparoscopic surgery. We describe an adult patient with a history of abdominal incisional hernia who developed BH that was treated safely by HALS.

Presentation of case: An 87-year-old woman was admitted to our hospital with nausea. She had a history of right hemicolectomy and repair of an abdominal incisional hernia using mesh at 5 years after hemicolectomy. Chest and abdominal computed tomography revealed herniation of the gastric corpus through the left posterior diaphragm. BH was diagnosed and hernia repair by HALS was selected as the approach because dense adhesions were expected in the abdominal cavity. The operation was performed safely and her postoperative course was uneventful.

Conclusion: HALS was useful, especially when removing adhesions around the hernial orifice. HALS is a feasible approach for BH and should be considered as one of the options in patients with a history of previous abdominal surgery.

Keywords: Abdominal incisional hernia; Bochdalek hernia; Case report; Hand-assisted laparoscopic surgery.

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Figures

Fig. 1
Fig. 1
Preoperative images of the Bochdalek hernia. CT reveals herniation of the gastric corpus through the left posterior diaphragm (white arrow) in a coronal view (a) and a sagittal view (b).
Fig. 2
Fig. 2
HALS for repair of the Bochdalek hernia. a. Adhesions around the hernial orifice were carefully removed by HALS. b. A 5 × 3 cm hernial orifice with a sac was observed. c. The defect was repaired with interrupted nonabsorbable sutures.
See this image and copyright information in PMC

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