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Laparoscopic repair of late-presenting Bochdalek hernia in 2 infants
Miyuki Kohno1, Hiromichi Ikawa, Shinya Okamoto
1Department of Pediatric Surgery, Kanazawa Medical University, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, Japan. miyuki@kanazawa-med.ac.jp
Insights
Laparoscopic repair of Bochdalek hernia in infants is feasible and effective. Key surgical considerations include organ protection, defect visualization, and identifying intestinal malrotation, offering advantages over thoracoscopic methods.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Bochdalek hernia is a congenital diaphragmatic defect that can present late in infancy.
- Surgical repair is necessary to prevent complications such as respiratory distress and gastrointestinal issues.
Observation:
- Two infants with late-presenting Bochdalek hernia underwent successful laparoscopic repair.
- Significant herniation of abdominal contents, including the small intestine, stomach, colon, and spleen, was observed in both cases.
Findings:
- Laparoscopic repair was technically successful in both patients.
- Critical surgical steps identified include: spleen protection during organ reduction, clear visualization of the diaphragmatic defect, adequate space for suturing, and detection of intestinal malrotation.
Implications:
- The laparoscopic approach offers advantages, particularly in identifying associated intestinal malrotation.
- This technique may be a superior alternative to thoracoscopy for Bochdalek hernia repair in infants and older children.
Abstract:
Laparoscopic repair was performed on 2 infants with late-presenting Bochdalek hernia. Intraoperatively, the entire small intestine was herniated in 1 case and the stomach, small intestine, and part of the colon and spleen were herniated in the other case. Laparoscopic repair of Bochdalek hernia was successfully completed in both the cases. On the basis of our experience, 4 points seem important in laparoscopic surgery for Bochdalek hernia: (1) avoiding damage to the spleen while reducing organs back into the abdominal cavity; (2) ensuring visualization of diaphragmatic defect after reducing the spleen and intestinal tract; (3) ensuring sufficient width to suture the dorsal side of the diaphragm; and (4) identifying intestinal malrotation. We believe that the fourth point represents an advantage of a laparoscopic approach, which seems superior to the thoracoscopic approach and could represent a useful therapy for Bochdalek hernia in infants and older patients.