Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report

Abstract Background Bochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited. Case presentation A 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient’s postoperative course was uneventful with no recurrences within the first year post-surgery. Conclusion Combined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.

Download Full-text

Bochdalek Hernia

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2018.v02.i02.p01 ◽

2018 ◽

Vol 2 (2) ◽

pp. 40

Author(s):

Yuliaji Narendra Putra ◽

Tubagus Odih Rhomdani Wahid ◽

Guntur Surya Alam ◽

Rohadi Rohadi

Keyword(s):

Abdominal Cavity ◽

Good Condition ◽

Left Lung ◽

Favourable Result ◽

Thoracic Cavity ◽

Bochdalek Hernia ◽

X Ray ◽

Post Surgery ◽

Abdominal Organs ◽

Chest X Ray

Background: Bochdalek hernia is a congenital defect on posterolateral diaphragm with an abnormal connection between the thoracic cavity and the abdominal cavity. This disease causes protrusion of abdominal organs into the thoracic cavity. Case: an 8-day-old baby girl admitted to hospital with shortness of breath 24 hours after delivered. The baby was born spontaneously assisted by midwife. Upon born, the baby was crying strongly and meconium came out 2 hours after birth. On physical examination, the abdomen was inspected flat. Darm contour and darm steifung was observed, and peristaltic sound was heard on left lung. Radiological examination demonstrated a diaphragmatic hernia with ileus obstruction. The patient underwent laparatomy and stomach, ileum, transverse colon, and spleen, was found on foramen Bochdalek. Post-surgery chest X Ray showed favourable result. Ten days after treatment, the patient was discharged in a good condition with no respiratory or digestive problems. After 1 months the patient’s condition remained good and there were no respiratory or digestive complaints. Conclusion: In a rare case like Bochadalek hernia, laparotomy performed as a promising attempt to return the anatomic position of organ.

Download Full-text

Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan

Surgical Case Reports ◽

10.1186/s40792-020-01003-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Toshimitsu Miyasaka ◽

Takeshi Matsutani ◽

Tsutomu Nomura ◽

Nobutoshi Hagiwara ◽

Naoto Chihara ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Abdominal Cavity ◽

Suture Technique ◽

Uneventful Recovery ◽

Bochdalek Hernia ◽

Direct Closure ◽

Hernia Sac ◽

Ischemic Change ◽

Life Threatening ◽

Laparoscopic Evaluation

Abstract Background A Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear. Case presentation A 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up. Conclusion A recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

Download Full-text

Right-sided Bochdalek hernia in an adult with hepatic malformation and intestinal malrotation

Surgical Case Reports ◽

10.1186/s40792-021-01232-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Naoki Enomoto ◽

Kazuhiko Yamada ◽

Daiki Kato ◽

Shusuke Yagi ◽

Hitomi Wake ◽

...

Keyword(s):

Elective Surgery ◽

Abdominal Cavity ◽

Three Dimensional ◽

Simulation Software ◽

3D Simulation ◽

Diaphragmatic Defect ◽

Intestinal Malrotation ◽

Intestinal Loop ◽

Bochdalek Hernia ◽

The Right

Abstract Background Bochdalek hernia is a common congenital diaphragmatic defect that usually manifests with cardiopulmonary insufficiency in neonates. It is very rare in adults, and symptomatic cases are mostly left-sided. Diaphragmatic defects generally warrant immediate surgical intervention to reduce the risk of incarceration or strangulation of the displaced viscera. Case presentation A 47-year-old woman presented with dyspnea on exertion. Computed tomography revealed that a large part of the intestinal loop with superior mesenteric vessels and the right kidney were displaced into the right thoracic cavity. Preoperative three-dimensional (3D) simulation software visualized detailed anatomy of displaced viscera and the precise location and size of the diaphragmatic defect. She underwent elective surgery after concomitant pulmonary hypertension was stabilized preoperatively. The laparotomic approach was adopted. Malformation of the liver and the presence of intestinal malrotation were confirmed during the operation. The distal part of the duodenum, jejunum, ileum, colon, and right kidney were reduced into the abdominal cavity consecutively. A large-sized oval defect was closed with monofilament polypropylene mesh. No complications occurred postoperatively. Conclusion Symptomatic right-sided Bochdalek hernia in adults is exceedingly rare and is frequently accompanied by various visceral anomalies. Accurate diagnosis and appropriate surgical repair are crucial to prevent possible incarceration or strangulation. The preoperative 3D simulation provided comprehensive information on anatomy and concomitant anomalies and helped surgeons plan the operation meticulously and perform procedures safely.

Download Full-text

New Concept for a Thoracic Drainage System Using Magnetic Actuation

Surgical Innovation ◽

10.1177/1553350619851685 ◽

2019 ◽

Vol 26 (6) ◽

pp. 705-711

Author(s):

Daisuke Taniguchi ◽

Keitaro Matsumoto ◽

Yoshihiro Kondo ◽

Tomoshi Tsuchiya ◽

Ikuo Yamamoto ◽

...

Keyword(s):

Abdominal Cavity ◽

Drainage System ◽

Magnetic Actuation ◽

Thoracic Cavity ◽

Common Procedure ◽

Thoracic Drainage ◽

Drain Fluid ◽

Laboratory Trial ◽

General Surgeons ◽

Effective Drainage

Objectives. Thoracic drainage is a common procedure to drain fluid, blood, or air from the pleural cavity. Some attempts to develop approaches to new thoracic drainage systems have been made; however, a simple tube is often currently used. The existing drain presupposes that it is placed correctly and that the tip does not require moving after insertion into the thoracic cavity. However, in some cases, the drain is not correctly placed and reinsertion of an additional drain is required, resulting in significant invasiveness to the patient. Therefore, a more effective drainage system is needed. This study aimed to develop and assess a new thoracic drain via a collaboration between medical and engineering personnel. Methods. We developed the concept of a controllable drain system using magnetic actuation. A dry laboratory trial and accompanying questionnaire assessment were performed by a group of thoracic and general surgeons. Objective mechanical measurements were obtained. Porcine experiments were also carried out. Results. In a dry laboratory trial, use of the controllable drain required significantly less time than that required by replacing the drain. The average satisfaction score of the new drainage system was 4.07 out of 5, indicating that most of the research participants were satisfied with the quality of the drain with a magnetic actuation. During the porcine experiment, the transfer of the tip of the drain was possible inside the thoracic cavity and abdominal cavity. Conclusion. This controllable thoracic drain could reduce the invasiveness for patients requiring thoracic or abdominal cavity drainage.

Download Full-text

Use of 2-octyl cyanoacrylate adhesive in rat liver induced lesion

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502012000900006 ◽

2012 ◽

Vol 27 (9) ◽

pp. 624-629 ◽

Cited By ~ 4

Author(s):

Orlando José dos Santos ◽

Giancarlo de Souza Marques ◽

Euler Nicolau Sauaia Filho ◽

Gustavo Medeiros Frota ◽

Rayan Haquim Pinheiro Santos ◽

...

Keyword(s):

Rat Liver ◽

Inflammatory Reaction ◽

Abdominal Cavity ◽

Healing Process ◽

Liver Lesion ◽

Adult Rats ◽

Catgut Suture ◽

Post Surgery ◽

Cyanoacrylate Adhesive ◽

Significant Difference

PURPOSE: To evaluate the healing process of rat traumatic liver lesion corrected with the use of 2-octyl cyanoacrylate adhesive, compared to the use of biologically absorbable chromed catgut thread suture. METHODS: Thirty mail adult rats were divided into two groups (15 per group) according to the used method for liver lesion correction as follows: adhesive group (AG), and catgut group (CG); each group being divided into three subsets of five animals (7th, 14th, and 21st day), respectively, according to post-surgery evaluation. All animals were submitted to homogeneous lesion applying synthetic bonding to AG and using chromed catgut suture to CG for lesion correction. Macroscopic and microscopic parameters of healing processes were evaluated. RESULTS: Both groups of animals showed excellent abdominal wall healing, with no evidence of infection, and no abdominal cavity peritonitis or abscess. The presence of adherence was observed in both groups with no statistically significant difference. As to macroscopic evaluation, there was statistically significant difference with respect to specific factors of clinical inflammation (ischemic inflammation and giant celular inflammatory reaction) between animals evaluated on the 10th day (ischemic necrosis and giant celular inflammatory reaction) among animals evaluated on the 14th day (A14 versus C14). CONCLUSION: Applying 2-octyl-cyanoacrylate adhesive for correcting rat liver lesion does not change healing process when compared to the use of chromed catgut stitch.

Download Full-text

Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1592135 ◽

2016 ◽

Vol 27 (03) ◽

pp. 274-279

Author(s):

Koji Fukumoto ◽

Masaya Yamoto ◽

Hiroshi Nouso ◽

Masakatsu Kaneshiro ◽

Mariko Koyama ◽

...

Keyword(s):

Hiatal Hernia ◽

Duodenal Obstruction ◽

Abdominal Cavity ◽

The Other ◽

Esophageal Hiatus ◽

Thoracic Cavity ◽

Toupet Fundoplication ◽

Cavity Volume ◽

Upper Gastrointestinal ◽

Asplenia Syndrome

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

Download Full-text

Prospective surveillance of breast cancer-related lymphoedema in the first-year post-surgery: feasibility and comparison of screening measures

Supportive Care in Cancer ◽

10.1007/s00520-014-2504-9 ◽

2014 ◽

Vol 23 (6) ◽

pp. 1549-1559 ◽

Cited By ~ 19

Author(s):

J. M. Blaney ◽

G. McCollum ◽

J. Lorimer ◽

J. Bradley ◽

R. Kennedy ◽

...

Keyword(s):

Breast Cancer ◽

First Year ◽

Prospective Surveillance ◽

Post Surgery ◽

Screening Measures

Download Full-text

Histological features of peritoneal lavage with ropivacaine in rats with fecal peritonitis

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502012000200016 ◽

2012 ◽

Vol 27 (2) ◽

pp. 193-199 ◽

Cited By ~ 5

Author(s):

Marcos Célio Brocco ◽

Renato Santiago Gomez ◽

Danilo Nagib Salomão Paulo ◽

Carlos Eduardo David de Almeida ◽

João Florêncio de Abreu Baptista

Keyword(s):

Saline Solution ◽

Peritoneal Lavage ◽

Abdominal Cavity ◽

Group Iv ◽

Histological Evaluation ◽

Fecal Peritonitis ◽

Control Groups ◽

Histological Features ◽

Post Surgery ◽

And Control

PURPOSE: To evaluate the histological features in lungs, peritoneum and liver of rats subjected to fecal peritonitis and treated with peritoneal lavage with 0.2% ropivacaine. METHODS: Twenty Wistar rats were subjected to laparotomy 6 h after the fecal peritonitis induction with autogenous stool. Rats were randomly distributed into 4 groups: I - (n=5) Control, no treatment; II - (n=5) Drying of the abdominal cavity; III - (n=5) Abdominal cavity lavage with 3 ml 0.9% saline solution and drying; and IV - (n=5) Abdominal cavity lavage with 3 ml 0.2% ropivacaine and drying. The animals that died underwent necropsy, and the surviving ones were subjected to euthanasia on the 11th day post-surgery. Fragments of liver, lungs and peritoneum were removed for histological evaluation. RESULTS: The animals that received peritoneal lavage (groups III and IV) showed greater survival than the drying and control groups. Lavage with ropivacaine prevented death during the observed period. Peritoneal lavage with ropivacaine maintained the architecture of the lung, peritoneum and liver without any important histological alterations. The histopathological findings analyzed correlated with greater survival of group IV. CONCLUSION: Treatment of fecal peritonitis in rats with peritoneal lavage using 0.2% ropivacaine demonstrated a reduction in histopathological alterations related to inflammatory response and sepsis.

Download Full-text

Bile acid, glucose, lipid profile, and liver enzyme changes in prediabetic patients 1 year after sleeve gastrectomy

BMC Surgery ◽

10.1186/s12893-020-00998-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tsz Kin Mak ◽

Shifang Huang ◽

Bingsheng Guan ◽

Hoyin Au ◽

Tsz Hong Chong ◽

...

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Bile Acid ◽

Liver Enzyme ◽

Total Bile Acid ◽

First Year ◽

Lipid Levels ◽

Post Surgery ◽

The Impact ◽

Enzyme Changes

Abstract Background Few articles have studied individuals with prediabetes after sleeve gastrectomy. Bile acid and lipid levels remain inconsistent in postbariatric patients. The purpose of this study was to explore bile acid, glucose, lipid, and liver enzyme changes in patients with different diabetes statuses who underwent sleeve gastrectomy. The impact of bariatric surgery and its potential benefits for prediabetic patients was also discussed. Methods A total of 202 overweight and obese patients who underwent bariatric surgery in our hospital between January 2016 and October 2018 were retrospectively reviewed. Patients were divided into prediabetes (n = 32), nondiabetes (n = 144), and diabetes (n = 26) groups and analysed. Glucose and lipid data were collected from medical records at baseline and at each follow-up visit. Result Significant improvements in body weight, glucose and lipid levels, and liver enzymes (P ≤ 0.05) in prediabetic patients were found throughout the first year postoperatively. Improvement in glycaemic control was first seen one month postoperatively, followed by persistent improvement in the next 12 months. Total bile acid (TBA) decreased, which was associated with ALT improvement in prediabetic patients 1-year post-surgery. There were no significant differences in HbA1c, glucose, or triglycerides (TGs) between prediabetic and T2DM patients or between prediabetic and nondiabetic patients at 12 months post-surgery. Conclusion LSG is highly effective at interfering with glucose and lipid levels as well as total bile acid levels in prediabetic patients in the first year postoperatively. Thus, LSG is indeed an alternative for overweight and obese prediabetic patients.

Download Full-text

Triple oxygen isotope variations in precipitation from southeast China and its hydrological significance

10.5194/egusphere-egu2020-6734 ◽

2020 ◽

Author(s):

Pengzhen Duan ◽

Sasadhar Mahata ◽

Lijuan Sha ◽

Hai Cheng

Keyword(s):

Oxygen Isotope ◽

Meteoric Water ◽

Meteorological Parameters ◽

Model Simulation ◽

Optical Measurements ◽

Water Isotopes ◽

First Year ◽

Southeast China ◽

Excess Loss ◽

Combined Use

&#160; &#160; High precision triple oxygen isotope measurement of meteoric water is a newly added tracer in hydrological and paleoclimate research. However, it is prerequisite to study the controls on precipitation 17O-excess for proper application of it. Here we report two years highly precise precipitation data from Nanjing, a southeast China station dominated by Asian monsoon. All the water isotopes (&#948;17O, &#948;18O and &#948;D) reported here are based on mass spectrometer measurements and optical measurements (cavity ring-down spectroscopy). Nanjing receives moisture from different vapor sources and experiences different rainout mechanisms during various monsoonal sessions. Combined use of above parameters can help us to delineate processes occurring during evaporation, transport, condensation and re-evaporation. Year to year 17O-excess variability is observed in the obtained dataset and no notable seasonal variation is observed. However, the 17O-excess seasonal amplitude is little larger in the first year than the subsequent year. So far, it is known that the precipitation 17O-excess depends on three values: 17O-excess of the source water bodies, amount of 17O-excess gain during evaporation and 17O-excess loss during raindrops evaporation. During dry months 17O-excess gain is balanced by 17O-excess loss, which might lead to the near absence of seasonal cycle at Nanjing. From the comparison of observed data and model simulation, the amount of re-evaporation on falling raindrop is estimated to be about 10% at Nanjing. In addition, correlation with available meteorological parameters has been discussed. Except temperature no significant correlation has been found with other metrological variables (relative humidity and rainfall amount). This study will serve as a baseline to understand some of issues in paleoclimate that have puzzled the scientific community for years.

Download Full-text