LAPAROSCOPIC SURGERY FOR GIANT ADULT BOCHDALEK DIAPHRAGMATIC HERNIA: COMBINED SUTURING AND POLYPROPYLENE MESH REPAIR

Congenital diaphragmatic hernias occur through embryologic defects in the diaphragm. A subset of adults (5-10 %) may present with a congenital hernia undetected during childhood. It requires surgery because of the risk of incarceration. An old lady having vomiting, upper abdominal pain, dyspnoea and retrosternal discomfort was diagnosed with the presence of a large left-sided Bochdalek diaphragmatic hernia and a hypoplastic lung. Laparoscopic repair was performed successfully after adequate preparation. The patient had postoperative respiratory difficulty and needed mechanical ventilation and intensive care for 5 days. She was discharged 8th POD. There was no recurrence in 32 months follow-up, though the hypoplastic left lung never recovered. Laparoscopy is proving to be more beneficial than laparotomy or thoracotomy. The use of a mesh further strengthens the defect and reduces chance of recurrence.