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2016 ; 8
(2
): 65-74
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Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults
#MMPMID27042603
Machado NO
N Am J Med Sci
2016[Feb]; 8
(2
): 65-74
PMID27042603
show ga
Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of
this hernia and its nonspecific presentation leads to delay in the diagnosis,
with the potential risk of complications. This review summarizes the relevant
aspects of its presentation and management, based on the present evidence in the
literature. A literature search was performed on PubMed, Google Scholar, and
EMBASE for articles in English on BH in adults. All case reports and series from
the period after 1955 till January 2015 were included. A total of 180 articles
comprising 368 cases were studied. The mean age of these patients was 51 years
(range 15-90 years) with a male preponderance of 57% (211/368). Significantly,
6.5% of patients were above 70 years, with 3.5% of these being above 80 years.
The majority of the hernias were on the left side (63%), with right-sided hernias
and bilateral occurring in 27% and 10%, respectively. Precipitating factors were
noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in
11%. The presenting symptoms included abdominal (62%), respiratory (40%),
obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of
them were asymptomatic (detected incidentally). In the 184 patients who underwent
surgical intervention, the surgical approach involved laparotomy in 74 (40.27%),
thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%),
laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall
recurrence rate of 1.6% was noted. Among these patients who underwent
laparoscopic repair, 82% underwent elective procedure; 66% underwent primary
repair, with 61% requiring interposition of mesh or reenforcement with or without
primary repair. The overall mortality was 2.7%. Therefore, BH should form one of
the differential diagnoses in patients who present with simultaneous abdominal
and chest symptoms. Minimal access surgery offers a good alternative with short
hospital stay and is associated with minimum morbidity and mortality.