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Research: Surgical management of symptomatic right-sided Bochdalek hernias in adults: when is a minimally invasive approach appropriate?

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Research: Surgical management of symptomatic right-sided Bochdalek hernias in adults: when is a minimally invasive approach appropriate?

ANZ J Surg

. 2020 Jun;90(6):1075-1079. doi: 10.1111/ans.15830. Epub 2020 Mar 16. https://pubmed.ncbi.nlm.nih.gov/32175658/

Surgical management of symptomatic right-sided Bochdalek hernias in adults: when is a minimally invasive approach appropriate?

Ngee-Soon Lau 1Michael Crawford 1Charbel Sandroussi 1Affiliations expand

Abstract

Background: Right-sided Bochdalek hernias are uncommon congenital diaphragmatic hernias that can be challenging to manage because they can contain bowel, omentum, kidney or liver.

Methods: We describe our experience at a single centre and integrate this with all reported cases in the literature to evaluate how this rare problem has been managed and when a minimally invasive approach is appropriate.

Results: A total of 31 patients were identified, four patients from our institution and 27 case reports from the literature. A minimally invasive approach was utilized in 15 of 31 patients (including two of four at our institution) and was more common if the operation was performed in the elective setting (10/12 versus 4/19). If a bowel resection was required, an open approach was more common (9/17 versus 1/14). The commonest method of repair was a primary suture repair (18/31), and the mesh was used in 13 cases, particularly in the elective setting (9/12 versus 4/19).

Conclusion: Right-sided Bochdalek hernias are an uncommon and challenging problem. These hernias can contain bowel, kidney and even liver but can still be successfully repaired using minimally invasive techniques, especially in the elective setting and when an emergency bowel resection is not required.

Keywords: Bochdalek hernia; minimally invasive surgery.

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