Saroj Sanjay Kumar, Kumar Satendra, Afaque Yusuf, Bhartia Abhishek Kumar, Bhartia Vishnu Kumar
Minimal Access Surgery, Institute of Medical Sciences, BHU, Varanasi, India.
General Surgery, Institute of Medical Sciences, BHU, Varanasi, India.
Minim Invasive Surg. 2016;2016:9032380. doi: 10.1155/2016/9032380. Epub 2016 Dec 15.
. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total = 13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands.
先天性膈疝通常在儿童期出现，但在成人中极为罕见。对于适合手术的有症状和无症状患者均需进行手术治疗。手术可通过剖腹术、开胸术、胸腔镜或腹腔镜进行。随着微创技术的出现，这种疝的开放手术修复率有所下降，且恢复早期、住院时间缩短，效果相当。本研究的目的是证实先天性膈疝的腹腔镜修复是一种安全有效的手术治疗方式。对2011年5月至2014年10月期间进行的腹腔镜膈疝修复术进行回顾性研究。纳入研究的共有13例（男/女：11/2）经CT扫描确诊为膈疝的病例，其中4例为Bochdalek疝（BH），8例为左侧膈膨升（ED），1例为右侧膈膨升（ED）。左侧发现的最大缺损为15×6厘米，右侧为15×8厘米。疝囊内容物包括胃、小肠、横结肠和大网膜。用超声刀还纳内容物，通常切除薄囊。将膈膨升折叠，用间断水平褥式缝合修补疝孔，并用特氟龙片加强。用不可吸收的固定钉固定复合补片。所有患者术后恢复良好，早期出院，随访正常，并进行了2年的随访。在经验丰富的医生手中，腹腔镜修复是先天性膈疝安全有效的手术治疗方式。
