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Cureus May 2024Congenital diaphragmatic hernias (CDH) occur as a result of genetic and environmental factors that occur during the early stages of fetal development. Overall, CDH are...
Congenital diaphragmatic hernias (CDH) occur as a result of genetic and environmental factors that occur during the early stages of fetal development. Overall, CDH are considered to be quite rare and are often discovered when patients are neonates. The patient in this case underwent a routine colonoscopy for high-risk polyps but then developed the sudden onset of cramping abdominal pain and PO (per os) intolerance. She was found to have a right-sided diaphragmatic hernia which ultimately required operative intervention. Retrospectively, a close review of prior imaging revealed a potential diaphragm defect. Post-colonoscopy diaphragmatic hernias are very rare and right-sided ones are rarer, making this case report an important addition to the literature.
PubMed: 38846239
DOI: 10.7759/cureus.59761 -
Langenbeck's Archives of Surgery Jun 2024The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost... (Meta-Analysis)
Meta-Analysis Comparative Study
PURPOSE
The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost associated with Robotic Surgery (RS) and Laparascopic Surgery (LS) in anti-reflux and hiatal hernia surgery.
METHODS
A comprehensive literature search was conducted using MEDLINE (via PubMed), Web of Science and Scopus databases. Studies comparing short-term outcomes and cost between RS and LS in patients with anti-reflux and hiatal hernia were included. Data on operative time, complications, length of stay, readmission rates, overall complications, mortality, and cost were extracted. Quality assessment of the included studies was performed using the MINORS scale.
RESULTS
Fourteen retrospective observational studies involving a total of 555,368 participants were included in the meta-analysis. The results showed no statistically significant difference in operative time, intraoperative complications, length of stay, readmission rates, overall complications, and mortality between RS and LS. However, LS was associated with lower costs compared to RS.
CONCLUSION
This systematic review and meta-analysis demonstrates that RS has non-inferior short-term outcomes in anti-reflux and hiatal hernia surgery, compared to LS. LS is more cost-effective, but RS offers potential benefits such as improved visualization and enhanced surgical techniques. Further research, including randomized controlled trials and long-term outcome studies, is needed to validate and refine these findings.
Topics: Humans; Hernia, Hiatal; Robotic Surgical Procedures; Laparoscopy; Gastroesophageal Reflux; Operative Time; Herniorrhaphy; Treatment Outcome; Length of Stay; Fundoplication; Patient Readmission; Postoperative Complications
PubMed: 38842610
DOI: 10.1007/s00423-024-03368-y -
Cureus May 2024Bochdalek's hernia is the most common congenital malformation of the diaphragm with a defect in its posterolateral part. Its clinical manifestation in adulthood is rare....
Bochdalek's hernia is the most common congenital malformation of the diaphragm with a defect in its posterolateral part. Its clinical manifestation in adulthood is rare. It is often an incidental finding, and its diagnosis may be challenging. A high index of suspicion is necessary, especially in cases presenting with cardiopulmonary or abdominal symptoms and an ambiguous finding on the initial chest X-ray. We present a case of an asymptomatic 50-year-old male patient with a bulky left-sided Bochdalek's hernia. Surgical treatment was indicated, and a direct suture of the defect after reduction of the herniated greater omentum, transverse colon, and tail of the pancreas was performed from the upper midline laparotomy. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. The management of adult patients with these kinds of hernias in both acute and chronic settings is discussed, and some recommendations are mentioned to minimize unnecessary pitfalls.
PubMed: 38832169
DOI: 10.7759/cureus.59635 -
Journal of Surgical Case Reports Jun 2024Morgagni hernia (MH) is a rare form of congenital diaphragmatic hernia, typically occurring predominantly on the right side and exhibiting a higher prevalence in...
Morgagni hernia (MH) is a rare form of congenital diaphragmatic hernia, typically occurring predominantly on the right side and exhibiting a higher prevalence in females. Usually diagnosed incidentally, MH may coexist with congenital heart defects, chest wall abnormalities and certain genetic syndromes such as Down syndrome. A 4-year-old boy with Down syndrome underwent simultaneous repair of MH and closure of a ventricular septal defect (VSD). A vertical midline sternotomy was performed, and the VSD was repaired using the right atrium approach. Subsequently, MH repair was conducted. Three weeks after the surgery, this patient developed a complete heart block, which lead to the implantation of a VVI pacemaker.
PubMed: 38832060
DOI: 10.1093/jscr/rjae301 -
Journal of Surgical Case Reports Jun 2024Diaphragmatic hernias occur in up to 10%-50% of the general population. Treatment of hiatal hernias depends on the type of hernia and the severity of the symptoms. We...
Diaphragmatic hernias occur in up to 10%-50% of the general population. Treatment of hiatal hernias depends on the type of hernia and the severity of the symptoms. We report the case of a 52-year-old woman with no significant history who presented for 1 year with non-specific chest pain, dyspnea, dysphagia, and heartburn. A thoracoabdominal tomography with contrast was performed, showing a diaphragmatic hernia containing the stomach, portions of the duodenum, pancreas, small intestine, and colon with a sac of up to 20 cm, which was successfully repaired laparoscopically.
PubMed: 38832059
DOI: 10.1093/jscr/rjae387 -
Endoscopy Dec 2024
Topics: Humans; Hernia, Hiatal; Gastroesophageal Reflux; Male; Female; Middle Aged
PubMed: 38830611
DOI: 10.1055/a-2318-3222 -
Cureus Jun 2024Hiatal hernias, characterized by the protrusion of internal organs through the diaphragmatic hiatus, are commonly seen in the elderly age group. While surgical...
Hiatal hernias, characterized by the protrusion of internal organs through the diaphragmatic hiatus, are commonly seen in the elderly age group. While surgical management remains debatable for asymptomatic cases, emergent complications necessitate prompt intervention. Here, we present a case of a 69-year-old female with a history of diaphragmatic hernia, who developed acute hypoxic respiratory failure secondary to acute pleural effusion caused by paraesophageal hernia rupture. Despite initial inconclusive imaging, a CT scan revealed the severity, prompting emergent management. The patient underwent esophageal stent placement, video-assisted thoracoscopic surgery-assisted total lung decortication, and three chest tubes placement, followed by antimicrobial therapy. Favorable outcomes were achieved with multidisciplinary intervention, highlighting the importance of timely recognition and comprehensive diagnostic approaches. This case underscores the potential severity of hiatal hernias, particularly paraesophageal types, necessitating vigilance among clinicians for timely intervention. It also emphasizes the effectiveness of combined surgical and medical multidisciplinary approaches in such emergent situations for optimal patient outcomes.
PubMed: 38827418
DOI: 10.7759/cureus.61518 -
Cureus May 2024Although the exact incidence of traumatic diaphragmatic hernia (TDH) is unknown, it can carry significant morbidity if not treated promptly. TDH is thought to be more...
Although the exact incidence of traumatic diaphragmatic hernia (TDH) is unknown, it can carry significant morbidity if not treated promptly. TDH is thought to be more common in penetrating thoracoabdominal trauma compared to blunt trauma. The left side is thought to be more commonly affected than the right due to the protective effects of the liver on the right hemidiaphragm in trauma. Although large defects are evident on CT imaging and the detection rate is improved with higher resolution CT scanners, smaller ruptures may require laparoscopy for definitive diagnosis if there is a high index of suspicion. In this case report, we present a case of a missed left TDH on CT imaging, with eventual herniation of the omentum and stomach. Although TDH traditionally is approached via thoracotomy or laparotomy, we demonstrate that a transabdominal minimally invasive approach with robot-assisted laparoscopic repair is a viable option, with the potential to reduce the morbidities associated with the open approach.
PubMed: 38826886
DOI: 10.7759/cureus.59450 -
BMC Pediatrics Jun 2024
PubMed: 38824523
DOI: 10.1186/s12887-024-04863-3 -
The Journal of Pediatrics May 2024To describe the typical clinical course of reversible persistent pulmonary hypertension of the newborn (PPHN) from perinatal etiologies and compare that with the...
OBJECTIVES
To describe the typical clinical course of reversible persistent pulmonary hypertension of the newborn (PPHN) from perinatal etiologies and compare that with the clinical course of PPHN due to underlying fetal developmental etiologies.
STUDY DESIGN
This was a single-center, retrospective cohort study of liveborn newborns either born or transferred to our facility for higher level of care between 2015 and 2020 with gestational age ≥35 weeks and a clinical diagnosis of PPHN in the electronic health record. Newborns with complex congenital heart disease and congenital diaphragmatic hernia were excluded. Using all data available at time of collection, newborns were stratified into 2 groups by PPHN etiology - perinatal and fetal developmental causes. Primary outcomes were age at initiation, discontinuation, and total duration of extracorporeal life support, mechanical ventilation, supplemental oxygen, inhaled nitric oxide, inotropic support, and prostaglandin E1. Our secondary outcome was age at echocardiographic resolution of pulmonary hypertension. Groups were compared by t-test. Time-to-event Kaplan Meier curves described and compared (log-rank test) discontinuation of each therapy.
RESULTS
Sixty-four (72%) newborns had perinatal etiologies whereas 24 (28%) had fetal developmental etiologies. The resolution of perinatal PPHN was more rapid compared with fetal developmental PPHN. By 10 days of age, more neonates were off inotropes (98% vs 29%, P < .01), decannulated from extracorporeal life support (100% vs 0%, P < .01), extubated (75% vs 37%, P < .01), and had echocardiographic resolution of PH (35% vs 7%, P = .02).
CONCLUSIONS
An atypical PPHN course, characterized by persistent targeted therapies in the second week of life, warrants further work-up for fetal developmental causes.
PubMed: 38823627
DOI: 10.1016/j.jpeds.2024.114131