Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study.
BACKGROUND
Diaphragmatic hernias may be congenital or acquired (traumatic). Some patients present in adulthood with a congenital hernia undetected during childhood or due to trauma, known as the adult-onset type. The authors present their series of adult-onset type diaphragmatic hernias managed successfully by laparoscopy.


METHODS
This study retrospectively investigated 21 adult patients between 1995 and 2007 who underwent laparoscopic repair at the authors' institution, 15 of whom were symptomatic. Laparoscopic repair was performed with mesh for 18 patients and without mesh for three patients who had Morgagni hernia.


RESULTS
In this series, Bochdalek hernia (n = 12), Morgagni hernia (n = 3), eventration (n = 3), and chronic traumatic hernia (n = 3) were treated. Intercostal drainage was required for 14 patients, whereas in three cases the hypoplastic lung never reinflated even after surgery. The time of discharge was in the range of postoperative days 4 to 9. The complication rate was 19%, and mortality rate was 4.5%. One case of recurrence was noted after 10 months.


CONCLUSIONS
The controversies involved are the surgical approach, management of the hernial sac, whether or not to suture the defect, and choice of prosthesis. Although laparoscopic and thoracoscopic approaches are comparable, the laparoscopic approach seems to have certain distinct advantages. The authors prefer not to excise the hernial sac and favor suturing the defects before mesh reinforcement. Regarding the type of mesh used, composite, expanded polytetrafluoroethylene (ePTFE), or polypropylene are the available options. Laparoscopic repair is feasible, effective, and reliable. It could become the gold standard in the near future.
Palanivelu
Chinnusamy
C
GEM Hospital and Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore, India. drcp@gemhospital.net
Rangarajan
Muthukumaran
M
Rajapandian
Subbiah
S
Amar
Vennapusa
V
Parthasarathi
Ramakrishnan
R
D000328:Adult; D003965:Diaphragmatic Eventration / Q000601:surgery*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques