title: Laparoscopic repair of diaphragmatic hernias: experience of six cases.
abstract: OBJECTIVE
  Laparoscopic diaphragmatic hernia repair is increasingly performed in adults for congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias. This study reviewed our experience with laparoscopic diaphragmatic hernia repair to evaluate its safety, efficacy and outcomes.
  
  
  METHODS
  Between January 1999 and December 2002, four male and two female patients presented to us with diaphragmatic hernias, three with traumatic and three with congenital hernias. The mean age of patients was 58.6 years (range, 42-83 years). Five patients presented with main complaints of postprandial retrosternal/chest discomfort and one patient had an acute gastric outlet obstruction. Dissection was performed laparoscopically to reduce the contents of the sac and the hernial defect was repaired using prolene sutures and a polypropylene mesh.
  
  
  RESULTS
  Laparoscopic repair of diaphragmatic hernias was completed successfully in all patients. The mean size of the defect was 6.8 cm (range, 3-12 cm) and the mean operative time was 100 minutes (range, 60-150 minutes). There were no major intraoperative complications. One patient required placement of a chest tube due to inadvertent opening of the pleura with the hernial sac and one patient had prolonged postoperative gastric ileus. The mean hospital stay was 2.3 days (range, 1-4 days) and the mean pain score was 4 (range, 2-6). All patients remained asymptomatic over a mean follow-up of 2.9 years.
  
  
  CONCLUSIONS
  Adult congenital and chronic traumatic diaphragmatic hernias are amenable to laparoscopic repair. Laparoscopic repair is safe and feasible and confers all the advantages of minimal access surgery.
authors.affiliation: Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Wadhwa
authors.forename: Jasti B K
authors.initials: JB
authors.lastname: Surendra
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006549:Hernia, Diaphragmatic, Traumatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome