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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
F Signorini, S Reimondez, P Maldonado, V Gorodner, L Obeide, F Moser, N Bollati
Surgical intervention
11 months ago
2158 views
177 likes
0 comments
10:10
Laparoscopic repair of giant left Bochdalek hernia in adults: resolution of 2 cases
A Bochdalek hernia is a congenital diaphragmatic defect which results from the improper fusion of the septum transversum and of the pleuroperitoneal folds. It rarely persists asymptomatically until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases, using open surgery or laparoscopy/thoracoscopy.
We present two cases of fully laparoscopic repair of a giant Bochdalek hernia in adults. In both cases, we used a GORE® DUALMESH® biomaterial and we had no complications and no recurrence. It is worth mentioning that the hernia sac was not found in any of the cases. This has been described as a distinct characteristic, which confirms the diagnosis.
Bochdalek hernia in adults is a rare entity, which requires surgical treatment to prevent any complications.
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
A D'Urso, P Saleg, D Mutter, J Marescaux
Surgical intervention
1 year ago
1654 views
112 likes
0 comments
09:10
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
F Terrazas, J Lorenzo Silva, D Molina, A Gonzalez, H Bravo
Surgical intervention
2 years ago
2164 views
119 likes
1 comment
06:34
Full laparoscopic repair of a post-traumatic diaphragmatic hernia with mesh insertion
This is the case of a 34-year-old man who suffered from a blunt trauma, 8 months before this surgery. He presented with oppressive chest pain, lasting for a week, increasing while exercising and decreasing when lying down. No history of chronic pathology or smoking was reported. He was admitted to hospital. CT-scan of the abdomen and thorax showed a left diaphragmatic hernia. A laparoscopic diaphragmatic hernioplasty was decided upon. The patient is placed in a right semi-lateral decubitus position, with a 45-degree tilt.
Three trocars were placed; two 5mm trocars in the left upper quadrant, in the anterior axillary line, and in the epigastrium, while a 12mm optical trocar is placed in the upper left quadrant, in the midclavicular line.
The left lung is collapsed. Laparoscopy revealed a left diaphragmatic defect, with a diaphragmatic hernia which contains the spleen, small bowel loops, and the omentum. The hernia contents are reduced into the abdominal cavity. The diaphragmatic defect is then sutured with non-absorbable material. A GORE® DUALMESH® biomaterial is placed over the previous defect and attached to the diaphragm with steel ENDO TACKERS™. A pleurostomy tube is placed and the lung is expanded. The patient outcome was uneventful and he was discharged 5 days after the procedure.
Laparoscopic repair of a diaphragmatic hernia after thoracic surgery with mesh insertion
Traumatic diaphragmatic hernias have been well described after blunt trauma. Diaphragmatic ruptures can occur in up to 0.8 to 7% of blunt abdominal trauma, with large left-sided defects being the most common. If the injury goes unrecognized, progressive herniation of abdominal contents may follow.
We report the case of a diaphragmatic hernia in a 48-year-old woman. The patient reports dyspnea and vomiting after left diaphragmatic node resection (diaphragmatic granuloma) one year ago.
A CT-scan demonstrated a large defect within the left hemi-diaphragm, associated with a herniation of the antrum, body of the stomach, colon, and spleen into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with a big herniation is shown. The hernia was reduced laparoscopically, and the defect was repaired with interrupted absorbable sutures and reinforced with continuous sutures. An intraperitoneal mesh was placed. The patient recovered uneventfully.
Diagnosis of a traumatic diaphragmatic hernia in the acute setting can be very challenging. In the chronic period, a myriad of symptoms and radiological findings may arise. Plain films, CT-scan, magnetic resonance imaging, and even diagnostic laparoscopy can help with the diagnosis. Laparoscopy is a safe and feasible method to repair traumatic diaphragmatic hernias, especially in the chronic setting, with the advantage of evaluating the entire abdomen and both hemi-diaphragms simultaneously.
FE Viamontes Ugalde, A Abascal Amo, J Delgado Valdueza
Surgical intervention
3 years ago
1486 views
63 likes
0 comments
12:52
Laparoscopic repair of a diaphragmatic hernia after thoracic surgery with mesh insertion
Traumatic diaphragmatic hernias have been well described after blunt trauma. Diaphragmatic ruptures can occur in up to 0.8 to 7% of blunt abdominal trauma, with large left-sided defects being the most common. If the injury goes unrecognized, progressive herniation of abdominal contents may follow.
We report the case of a diaphragmatic hernia in a 48-year-old woman. The patient reports dyspnea and vomiting after left diaphragmatic node resection (diaphragmatic granuloma) one year ago.
A CT-scan demonstrated a large defect within the left hemi-diaphragm, associated with a herniation of the antrum, body of the stomach, colon, and spleen into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with a big herniation is shown. The hernia was reduced laparoscopically, and the defect was repaired with interrupted absorbable sutures and reinforced with continuous sutures. An intraperitoneal mesh was placed. The patient recovered uneventfully.
Diagnosis of a traumatic diaphragmatic hernia in the acute setting can be very challenging. In the chronic period, a myriad of symptoms and radiological findings may arise. Plain films, CT-scan, magnetic resonance imaging, and even diagnostic laparoscopy can help with the diagnosis. Laparoscopy is a safe and feasible method to repair traumatic diaphragmatic hernias, especially in the chronic setting, with the advantage of evaluating the entire abdomen and both hemi-diaphragms simultaneously.
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
G Dapri, K Jottard, K Grozdev, D Guta, GB Cadière
Surgical intervention
3 years ago
980 views
32 likes
0 comments
07:14
Single incision laparoscopic non-traumatic left lateral diaphragmatic hernia repair
Background: A diaphragmatic hernia is a quite uncommon disease, being congenital or post-traumatic. Its diagnosis is frequently incidental. The surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit, because of reduced abdominal wall trauma and added advantages provided by minimally invasive surgery (MIS). Transumbilical single incision laparoscopy (TSIL), in addition to improved cosmetic results, can offer other advantages to MIS such as reduced postoperative pain, a shorter hospital stay, and improved patient comfort.
Video: The authors report the case of a 45-year-old man who consulted for a non-traumatic left lateral diaphragmatic hernia, which was discovered incidentally, and which was treated using TSIL suture and mesh reinforcement.
Results: Laparoscopic time was 104 minutes and perioperative bleeding was insignificant. The final umbilical scar was 15mm. During the postoperative course, only 4 grams of paracetamol were used. The patient was discharged on the 1st postoperative day, after chest X-ray control. At consultation, the patient did not report the use of painkillers and, at 1, 6, and 12 months, the chest X-ray control was negative for recurrence.
Conclusions: Uncommon conditions, such as a lateral diaphragmatic hernia, can be approached using TSIL, because this technique adds an improved cosmetic result, a reduced postoperative pain, a shorter hospital stay, and an improved patient comfort.
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
4 years ago
677 views
10 likes
0 comments
04:02
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
D Lawrence, YV Wu, MJ Rosen
Surgical intervention
5 years ago
3597 views
72 likes
1 comment
08:45
Laparoscopic repair of a large right-sided Morgagni’s hernia
Morgagni’s hernias are rare congenital anterior diaphragmatic hernias for which the optimal method of repair is unknown. This video presents a morbidly obese woman with oxygen-dependent chronic obstructive pulmonary disease (COPD) along with a Morgagni’s hernia that compresses her entire right lung. Omentum and colon are seen herniating through the 10 by 15 centimeter defect. Through a laparoscopic approach, the intra-abdominal contents were reduced, the defect primarily closed, and reinforced with mesh. After the repair, the patient had significant improvements in her pulmonary status. Laparoscopic repair with mesh reinforcement is a viable and easily accomplished approach for Morgagni’s hernia repair.
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
A Rotundo, T Knowles, S Kadirkamanathan, M Harvey
Surgical intervention
7 years ago
4536 views
46 likes
1 comment
10:21
Laparoscopic repair of post-traumatic diaphragmatic hernia with mesh insertion
Traumatic injuries of the diaphragm are rare (0.8%-5.8% of all blunt trauma). Early diagnosis is difficult, and many reports have described delayed presentation of diaphragmatic hernia with subsequent significant morbidity and mortality.

We report a case of an acute diaphragmatic hernia in a 47-year-old male presenting 4 years after the traumatic episode (significant fall from a ladder). The patient was admitted to the emergency department with severe vomiting and dehydration. Once the patient was stabilised with fluid resuscitation and nasogastric tube aspiration, an urgent CT-scan was performed. This demonstrated a large defect within the left hemi-diaphragm, associated with herniation of both the antrum and body of the stomach, into the thoracic cavity.
At laparoscopy, a large rupture of the left hemi-diaphragm with herniation and rotation of the stomach was confirmed. The hernia was reduced laparoscopically, and the defect repaired with interrupted, non-absorbable polyester sutures (Ethibond 2/0, Ethicon) and a composite mesh (Proceed™, Ethicon). The patient made an uneventful recovery.
Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. In our experience, if the patient is haemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.