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.