DOI QR코드

DOI QR Code

Surgery for Diaphragmatic Hernia Repair: A Longitudinal Single-Institutional Experience

  • Siwon Oh (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suk Kyung Lim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jong Ho Cho (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hong Kwan Kim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yong Soo Choi (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jhingook Kim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Young Mog Shim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Junghee Lee (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2022.10.26
  • Accepted : 2022.12.22
  • Published : 2023.05.05

Abstract

Background: This study analyzed and described the clinical characteristics and surgical outcomes of diaphragmatic hernia (DH) repair according to the operative approach. Methods: After excluding cases with a combined approach and hiatal hernias, we analyzed 26 patients who underwent DH repair between 1994 and 2018. The baseline and perioperative characteristics of the thoracic approach group and the abdominal approach group were described and analyzed. Results: Fifteen of the 26 patients were treated through the thoracic approach, including 5 patients who underwent video-assisted thoracic surgery (VATS). Eleven patients underwent the abdominal approach. The thoracic approach was associated with a longer duration of DH than the abdominal approach (2 vs. 0.1 months), herniation of the right-sided abdominal organs, and herniation of the retroperitoneal organs. During the median follow-up of 23 months, there was no recurrence of DH. Conclusion: The surgical approach should be chosen considering the duration of DH and the location of herniated organs. VATS might be a safe and feasible option for repairing DH.

Keywords

References

  1. Kirby E, Keijzer R. Congenital diaphragmatic hernia: current management strategies from antenatal diagnosis to long-term follow-up. Pediatr Surg Int 2020;36:415-29. https://doi.org/10.1007/s00383-020-04625-z
  2. Bosanquet D, Farboud A, Luckraz H. A review diaphragmatic injury. Respir Med CME 2009;2:1-6. https://doi.org/10.1016/j.rmedc.2009.01.002
  3. Hood RM. Traumatic diaphragmatic hernia. Ann Thorac Surg 1971;12:311-24. https://doi.org/10.1016/s0003-4975(10)65131-4
  4. Testini M, Girardi A, Isernia RM, et al. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg 2017;12:23. https://doi.org/10.1186/s13017-017-0134-5
  5. Zani A, Zani-Ruttenstock E, Pierro A. Advances in the surgical approach to congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2014;19:364-9. https://doi.org/10.1016/j.siny.2014.09.002
  6. Blitz M, Louie BE. Chronic traumatic diaphragmatic hernia. Thorac Surg Clin 2009;19:491-500. https://doi.org/10.1016/j.thorsurg.2009.08.001
  7. Hwang SW, Kim HY, Byun JH. Management of patients with traumatic rupture of the diaphragm. Korean J Thorac Cardiovasc Surg 2011;44:348-54. https://doi.org/10.5090/kjtcs.2011.44.5.348
  8. Thoman DS, Hui T, Phillips EH. Laparoscopic diaphragmatic hernia repair. Surg Endosc 2002;16:1345-9. https://doi.org/10.1007/s00464-001-8162-2
  9. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg 1995;60:1444-9. https://doi.org/10.1016/0003-4975(95)00629-Y
  10. Minneci PC, Deans KJ, Kim P, Mathisen DJ. Foramen of Morgagni hernia: changes in diagnosis and treatment. Ann Thorac Surg 2004;77:1956-9. https://doi.org/10.1016/j.athoracsur.2003.12.028
  11. Lee JH, Han KN, Hong JI, Kim HK. A single-port video-assisted thoracoscopic surgery with CO2 insufflation for traumatic diaphragmatic hernia. Interact Cardiovasc Thorac Surg 2019;29:808-10. https://doi.org/10.1093/icvts/ivz173
  12. Theodorou CM, Jackson JE, Beres AL, Leshikar DE. Blunt traumatic diaphragmatic hernia in children: a systematic review. J Surg Res 2021;268:253-62. https://doi.org/10.1016/j.jss.2021.07.011
  13. Naunheim KS. Adult presentation of unusual diaphragmatic hernias. Chest Surg Clin N Am 1998;8:359-69.
  14. Hussain A, Hunt I. Acute diaphragmatic injuries associated with traumatic rib fractures: experiences of a major trauma centre and the importance of intra-pleural assessment. J Chest Surg 2021;54:59-64. https://doi.org/10.5090/kjtcs.20.126
  15. Ambrogi V, Forcella D, Gatti A, Vanni G, Mineo TC. Transthoracic repair of Morgagni's hernia: a 20-year experience from open to video-assisted approach. Surg Endosc 2007;21:587-91. https://doi.org/10.1007/s00464-006-9017-7
  16. Bawazir OA, Bawazir A. Congenital diaphragmatic hernia in neonates: open versus thoracoscopic repair. Afr J Paediatr Surg 2021;18:18-23. https://doi.org/10.4103/ajps.AJPS_76_20
  17. Lee J, Nam SH, Kim SW, Hong JM, Kim D. Diaphragmatic hernia with isolated shoulder pain evoked by surfeit. Ann Transl Med 2019;7:11. https://doi.org/10.21037/atm.2018.11.26
  18. Liem NT. Thoracoscopic approach in management of congenital diaphragmatic hernia. Pediatr Surg Int 2013;29:1061-4. https://doi.org/10.1007/s00383-013-3394-5
  19. Sirmali M, Turut H, Gezer S, et al. Clinical and radiologic evaluation of foramen of Morgagni hernias and the transthoracic approach. World J Surg 2005;29:1520-4. https://doi.org/10.1007/s00268-005-0055-4
  20. Bendixen M, Jorgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomized controlled trial. Lancet Oncol 2016;17:836-44. https://doi.org/10.1016/S1470-2045(16)00173-X
  21. Boffa DJ, Kosinski AS, Furnary AP, et al. Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy. J Clin Oncol 2018;36:2378-85. https://doi.org/10.1200/JCO.2018.77.8977