Page 49 - World Journal of Laparoscopic Surgery

Laparoscopic Diaphragmatic Repair

Figs 1A and B: (A) Preoperative; (B) Postoperative chest X-ray of eventration

Fig. 2: The CECT abdomen image of Bochdalek hernia

tilt and sand bag under lower chest. Pneumoperitoneum created All cases were followed up with 1 week postoperative and
with Veress needle. Lower intra-abdominal pressure was used (10 quarterly chest X-rays.
mm Hg). A 10-mm umbilical port was used for camera with 30°/45°
laparoscope and the remaining 5 mm ports placed as needed results
(Fig. 4). A total of five cases underwent laparoscopic diaphragmatic repair,
For hernias, after reducing the contents, the sac was excised and their characteristics are tabulated in Table 1.
safely (Fig. 5). In the case of eventration, small rent was made in The average age was 43.4 years (21 to 30 = one, 31 to 40 years =
the thinned out diaphragm to create pneumothorax and reduce three, 71 to 80 years = one). Three of five cases were males (M:F =
tension on diaphragm, the redundant thinned out sac was excised. 3:2). Four of five cases were on the left side.
Reconstruction done with barbed polydioxanone sutures (V-Loc) All cases presented with the chief complaint of shortness of
and reinforced with mesh. In the case of traumatic rupture, breath on exertion, one case had a recent history of blunt trauma
transmigrated abdominal contents were replaced in the abdominal on the chest. None of the cases had features of obstruction.
cavity. Tension-free reconstruction was done with barbed PDS Mesh placed in four of five cases. The ICD kept in four five cases
suture with interrupted ethibond sutures. The ICD was placed under and removed on the second postoperative day. None required
vision before the defect closure (Fig. 6). conversion to open. Average operation time was 105 minutes. None

World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020) 47