Laparoscopic repair of incarcerated congenital diaphragmatic hernias presenting beyond the newborn period.
PURPOSE/BACKGROUND: Congenital diaphragmatic hernias (CDHs) diagnosed outside of the newborn period are an uncommon occurrence in developed countries. Incarceration of viscera presenting as bowel obstruction is a rare clinical scenario with only a few cases reported in the literature, all of which have been repaired via laparotomy. We have recently encountered a series of these cases that we approached laparoscopically. SUBJECTS AND METHODS: We performed a retrospective review to identify patients who underwent laparoscopic repair of CDH with incarceration after the neonatal period. Demographics, presentation characteristics, operative details, and outcomes were reviewed. results: Between 2008 and 2011, three patients underwent laparoscopic repair of left-sided incarcerated CDH presenting with bowel obstruction. The mean age was 60.8 months (range, 2-157 months) with a mean weight of 30.2 kg (range, 11-66.5 kg). All cases were completed laparoscopically using a 5-mm umbilical port with three to four additional 3-mm instruments. The mean operative time was 133 minutes (range, 117-164 minutes). There were no intraoperative or postoperative complications. Mean length of hospital stay was 4 days (range, 1-8 days). Median follow-up was 6.3 months (range, 0.8-42.3 months). One patient suffered a recurrence after a motor vehicle collision and subsequently underwent a successful second laparoscopic repair. CONCLUSIONS: The laparoscopic approach for patients presenting with an incarcerated CDH beyond the newborn period appears to be an appropriate approach and should be considered when this diagnosis is encountered.
Pettiford-Cunningham, J; Adibe, OO; Gasior, AC; Ostlie, DJ; St Peter, SD
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