Laparoscopic patch repair of diaphragmatic hernias with Surgisis.J Pediatr Surg. 2005 Aug; 40(8):E1-5.JP
Laparoscopic repair of congenital diaphragmatic hernias has been sparsely reported. Moreover, each report has primarily been a single operative case. In most of the reports, prosthetic mesh has not been used, and when used, it has been nonabsorbable in nature. Most of these case reports have documented only a few months of clinical follow-up.
After institutional review board approval (No. 01-12-115X), the clinical course and outcome of 3 patients undergoing laparoscopic repair of foramen of Morgagni and Bochdalek hernias using 4-ply Surgisis soft tissue graft (Cook Inc, Bloomington, Ind) were reviewed to determine if this approach is appropriate.
In 2001, 2 patients, ages 9 months and 14 years, underwent laparoscopic foramen of Morgagni repair and one 5-day-old underwent laparoscopic foramen of Bochdalek repair using Surgisis soft tissue graft as a patch to close the diaphragmatic defects because there was too much tension with primary repair. In each case, the prosthesis was secured to the rim of the defect using interrupted silk sutures tied intracorporally. The mean operative time for repair of the Morgagni defects was 230 minutes with a postoperative discharge of 1 and 2 days. For the foramen of Bochdalek repair, the operative time was 204 minutes, and the patient was discharged at 3 weeks. No complications have occurred during or after any of the procedures, but the oldest patient underwent diagnostic laparoscopy 3 months postoperatively for a radiographic finding of suspected recurrence. At laparoscopy, the patch was intact, and no diaphragmatic hernia was noted.
Laparoscopic repair of congenital diaphragmatic defects using prosthetic material is possible although the operative time required is around 3.5 hours. Because of the brief postoperative course, the laparoscopic approach appears justified in the nonneonatal patients. Whether this approach is appropriate for repair of neonatal Bochdalek hernias remains unclear.