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Laparoscopic patch repair of recurrent anterior diaphragmatic hernia in a child with SMA
Noemi Cantone1, Francesca Destro1, Michele Libri1
1S. Orsola Malpighi Hospita, Pediatric Surgery Unit, Via Massarenti 11, 40138 Bologna, Italy.
Insights
Anterior congenital diaphragmatic hernia (CDH) in a patient with spinal muscular atrophy (SMA) recurred after initial laparoscopic repair. Patch repair via laparoscopy is recommended for neuromuscular patients to prevent recurrence.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Genetics
Background:
- Anterior congenital diaphragmatic hernia (CDH) is a rare condition where abdominal organs protrude into the chest cavity through a defect in the diaphragm.
- Spinal muscular atrophy (SMA) is a neuromuscular disorder that can affect respiratory function and abdominal pressure.
- Surgical correction is typically required for CDH, even when asymptomatic.
Observation:
- A 6-year-old girl with SMA was diagnosed with anterior CDH.
- The patient underwent laparoscopic CDH repair, but experienced recurrence four years later.
- A second laparoscopic procedure successfully closed the recurrent hernia using a GORE-TEX patch.
Findings:
- Recurrence of anterior CDH in patients with neuromuscular diseases like SMA may be linked to altered respiratory dynamics and increased abdominal pressure, potentially exacerbated by scoliosis.
- Patch interposition during surgical repair is crucial in these patients to minimize tension on the closure margins and reduce recurrence risk.
Implications:
- Laparoscopic surgery is a safe and effective approach for correcting CDH, even in cases of recurrence and when mesh or patch use is necessary.
- Considering patch augmentation in primary CDH repair for patients with neuromuscular conditions like SMA may be beneficial to prevent recurrence.
Abstract:
An anterior congenital diaphragmatic hernia (CDH) is a diaphragmatic defect that allows the passage of abdominal organs into the thorax. It is typically asymptomatic (the diagnosis is incidental) and it requires surgical correction. In this paper we present a 6 year-old girl affected by spinal muscular atrophy (SMA) who was diagnosed with anterior CDH. Four years after laparoscopic closure of the defect by interrupted suture the girl returned for hernia recurrence. Another laparoscopic procedure was performed and the defect was closed using a GORE-TEX patch. We postulate a mechanism of altered respiratory dynamic and increased abdominal pressure related to scoliosis favouring CDH recurrence in patients with neuromuscular pathologies such as SMA. In these patients patch interposition should be considered in the first place in order to reduce tension over margins. Laparoscopy is a safe and feasible procedure for CDH correction also in case of recurrence and when the interposition of a patch is required.
