Calin Marius Liviu, Arevalo Gabriel, Harris Kathryn, Fuentes Rocio, Sadiq Aziz, Nasri Baongoc, Singh Kirpal
1 General Surgery, Saint Vincent Hospital Indianapolis , Indianapolis, Indiana.
2 Department of Surgery, Bronx Lebanon Hospital , New York, New York.
J Laparoendosc Adv Surg Tech A. 2017 Mar;27(3):283-287. doi: 10.1089/lap.2016.0392. Epub 2016 Sep 1.
As an advanced minimally invasive surgical procedure, the repair of the diaphragmatic hernia may sometimes be very challenging especially when the anatomy is unclear.
We are presenting a rare case of a parahiatal hernia defect repair where the understanding of the anatomy was complicated by the presence of an unusual large sized left inferior phrenic artery. The Da Vinci surgical platform was used to perform the entire procedure. Hernia sac dissection, identification of the crura, primary closure of the defect, and use of biologic mesh reinforcement were the main steps performed in the usual manner for hernia repair. In addition, the use of intraoperative ultrasound was of great utility to clarify the vascular anatomy.
The additional time required for the intraoperative ultrasound and identification of the vascular anatomy has increased the duration of the procedure that otherwise was uneventful. The accurate identification of the anatomy allowed for a safe surgical outcome. The postoperative course was favorable and patient was free of symptoms at 1-month follow-up.
The challenge of the repair of this rare, parahiatal type of diaphragmatic hernia where a large sized left inferior phrenic artery was also encountered was successfully mitigated by the use of the intraoperative Doppler ultrasound and by compliance with the basic steps of the procedure.
作为一种先进的微创手术，膈疝修补术有时可能极具挑战性，尤其是在解剖结构不清晰的情况下。
我们报告一例罕见的食管裂孔旁疝缺损修补病例，由于存在异常粗大的左下膈动脉，解剖结构的识别变得复杂。整个手术过程使用达芬奇手术平台进行。疝囊剥离、膈脚识别、缺损的一期缝合以及生物补片加固的使用是疝修补常规操作的主要步骤。此外，术中超声的使用对于明确血管解剖结构非常有用。
术中超声检查和血管解剖结构识别所需的额外时间增加了原本顺利的手术时长。解剖结构的准确识别确保了手术的安全结果。术后病程顺利，患者在1个月随访时无症状。
通过使用术中多普勒超声并遵循手术基本步骤，成功应对了这种罕见的食管裂孔旁型膈疝修补挑战，该病例还伴有粗大的左下膈动脉。
