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Congenital diaphragmatic hernia in adults: a decade of experience from a single tertiary center
Henriikka Hietaniemi1,2, Tommi Järvinen2,3, Ilkka Ilonen2,3
1Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.
Insights
Laparoscopic repair of adult congenital diaphragmatic hernias (CDHs) is safe and effective. This minimally invasive approach offers a shorter hospital stay and fewer complications compared to open surgery.
Area of Science:
- Surgical outcomes
- Minimally invasive surgery
- Hernia repair
Background:
- Congenital diaphragmatic hernias (CDHs) are rare in adults.
- CDHs can lead to severe gastrointestinal and respiratory symptoms.
- Adult CDHs may present with bowel incarceration and strangulation.
Purpose of the Study:
- To analyze surgical outcomes in adult patients with congenital diaphragmatic hernias.
- To compare complication rates, reoperations, and mortality between laparoscopic and open hernia repair.
- To evaluate the safety and efficacy of different surgical approaches for adult CDHs.
Main Methods:
- Retrospective analysis of adult patients with Morgagni or Bochdalek hernias.
- Data collection on demographics, surgical characteristics, mortality, and morbidity from 2010-2019.
- Comparison of outcomes between minimally invasive (laparoscopic) and open hernia repair.
Main Results:
- 37 adult patients were identified, with 78.4% undergoing minimally invasive surgery.
- 18.9% of patients experienced Clavien-Dindo grade II-V complications.
- Minimally invasive repair resulted in a significantly shorter hospital stay (3.6 days vs. 6.8 days).
- No 90-day mortality or short/long-term recurrences were observed.
Conclusions:
- Laparoscopic repair of adult congenital diaphragmatic hernias is safe and effective.
- Minimally invasive surgery is associated with reduced hospital stay and lower complication rates.
- Adult CDH repair via laparoscopy offers favorable short-term and long-term outcomes.
Introduction:
Congenital diaphragmatic hernias (CDHs) in adults remain rare, with limited data on them available. However, CDHs can cause respiratory and gastrointestinal symptoms in adults, even resulting in the strangulation of the bowel when incarcerated. Here, we aimed to analyze surgical outcomes among adult patients. The primary outcome of interest was the complication rate, reoperations and 90-day mortality after laparoscopic and open hernia repair.
Methods:
We identified all adult patients diagnosed with a Morgagni or Bochdalek hernia treated operatively between 2010 and 2019 in a single tertiary care hospital. Data on patient demographics, surgical characteristics, mortality and morbidity were collected.
Results:
In total, we identified 37 patients (67.6% female; average age, 57 years). Overall, 78.4% patients underwent minimally invasive operations, while 35.1% underwent emergency operations. A Clavien-Dindo grade II-V complication was experienced by 18.9% of patients. No deaths occurred within 90 days of surgery, and we detected no recurrences in short-term or long-term follow-up. A minimally invasive technique correlated with a shorter hospital stay of 3.6 days versus 6.8 days in the open surgery group (p = .007, t = 3.3, 95% confidence interval = 1.04-5.21).
Conclusion:
Our findings indicate that the laparoscopic repair of a congenital diaphragmatic hernia is safe and effective, offering short hospital stay and a low amount of complications.
