Giant Bochdalek Hernia: A Minimally Invasive Transabdominal Approach

A Bochdalek hernia is the most common congenital diaphragm hernia (CDH). It can rarely evade prenatal detection and persist into adulthood with minimal symptoms. Large CDH repair has often required an open approach in the past. In this article, we present a case of a patient with large CDH who was asymptomatic until later in her adult life who subsequently developed symptoms and sought a surgical evaluation. A minimally invasive transabdominal approach was used to effectively reduce and repair this rare giant hernia. The patient has remained free of recurrence and has had resolution of her symptoms after 18 months of follow-up. This case illustrates that even the largest of these can be handled in a minimally invasive fashion and achieve durable results.

521 PREOPERATIVE BOTULINUM TOXIN TYPE A: PROPOSAL OF A NEW STRATEGY FOR GIANT HERNIA MANAGEMENT

Botulinum toxin is already in use to treat abdominal wall giant hernia. The concept is to reduce pressure e create new space in the abdominal compartiment after the surgey. We show a case that a similar aproach was used to treat giant hiatal hernia. Methods We used botulinum toxin 4 weeks prior the surgery to increase de abdominal compartment. it was checked in a ct scan. Results The surgey was performed with a hiatoplasty, fundoplication and a gastropexy. Conclusion The use of botulinum seens to be a new stragy for selected cases. Video https://www.dropbox.com/s/td7fr3a6buejqnd/Bianchi%20ET%20botox.wmv?dl=0.

Method of treatment of giant hernias of the esophageal opening of the diaphragm. Clinical case

The treatment of giant hiatal hernias with the need to perform a cruroplasty is an urgent problem. This article describes a new method of treating a hernia of the esophageal opening of the diaphragm with laparoscopic access, using a combined xenopericard endoprosthesis as an implant. A clinical observation was carried out. Conclusion: this observation indicates the possibility of using a combined implant a xenopericard band for cruroplasty with giant hernia hiatal, which creates a strong anti-adhesive frame hiatal.

Intraoperative Fascia Tension as an Alternative to Component Separation. A Prospective Observational Study

Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal closure. This prospective observational study aims to clarify the extent to which this traction method can function as an alternative to component separation (CS) methods.Methods: We included data of 21 patients treated with intraoperative fascia stretching in seven specialized hernia centers between November 2019 and August 2020.Results: Intraoperatively-measured fascial distance averaged 17.3 cm (range 8.5–44 cm). After application of diagonal-anterior traction >10 kg for an average duration of 32.3 min (range 30–40 min), the fascial distance decreased by 9.8 cm (1–26 cm) to an average 7.5 cm (range 2–19 cm), which is a large effect (r = 0.62). The fascial length increase (average 9.8 cm) after applied traction was highly significant. All hernias were closed under moderate tension after the traction phase. In 19 patients, this closure was reinforced with mesh using a sublay technique.Conclusion: This method allows primary closure of complex (LOD) hernias and is potentially less prone to complications than component separation (CS) methods.

Complications and relapses after alloplasty of large and giant hernia of the esophageal aperture of the diaphragm

The review of the literature presents the content analysis of surgical treatment of large and giant hernia of the esophageal aperture of the diaphragm as well as the analyses of complications when using the main methods of hernioplasty. Alloplasty of the esophageal aperture of the diaphragm remains a large and unresolved surgical problem, as evidenced by the analyzed literature sources, mainly reviews and clinical recommendations.Firstly, alloplasty can cause postoperative complications with a frequency of up to 20%, especially when using rigid polypropylene and composite polytetrafluoroethylene mesh implants with circular paraesophageal fixation. Modern biological nets now show high incidence of anatomical relapses, so most specialists continue to use synthetic implants, of which the most promising ones are lightweight, mesh, partially absorbable structures.Secondly, clear indications for alloplasty have not been developed, for example, according to the size of the hernia of the esophageal opening in the diaphragm, which is the main risk factor for relapses.Thirdly, it is still not clear what indicator should be used to estimate the size of hernia of the esophageal aperture of the diaphragm and, therefore, it is not clearly defined which hernias are considered small, which are large and which are giant, despite the fact that the three terms constantly appear in the medical literature.Fourthly, the optimal technique for alloplasty has not been determined with large and especially giant hernias, which would prevent anatomical relapses, and at the same time would not cause postoperative complications.It is necessary to outline the following ways to solve these problems: to develop effective and at the same time safe methods of alloplasty of large and giant hernias; to determine clear indications for alloplasty of the esophageal opening of the diaphragm, depending on the size of hernias; to create an appropriate, applied classification of hernias of the esophageal aperture of the diaphragm.