Diaphragmatic and Hiatal Hernias Repairs
Hernias can occur through the muscular partition or diaphragm, which divides the abdomen and chest. These hernias are often congenital (from birth) or occur later in life following trauma. In these situations, organs inside the abdominal cavity can migrate into the chest.
Diaphragmatic hernias can vary in type based on the location of the defect, and the organs that herniate or migrate can differ. The most common structures to migrate include the stomach, omentum (fat curtain), large intestine, spleen, a portion of the liver, small intestine, left kidney, and rarely, the pancreas.
The migrating organs put pressure mainly on the lungs and other chest organs, compromising their function. As these are structural defects in the muscles, surgery is the treatment of choice.
Symptoms:
- Chest pain and discomfort
- Abdominal pain
- Shortness of breath
- Recurrent cough
- Difficulty in doing stressful work
- Fullness after food consumption
- Reflux or food returning to the chest
- Difficulty in lying on the back
- Abdominal bloating
- Nausea
- Vomiting
- Feeling of food getting stuck in the chest
- Constipation
Diagnosis:
- Ultrasound abdomen and pelvis
- ECG, ECHO, Chest X-ray
- CT abdomen and pelvis with oral and intravenous contrast
- Pulmonary function tests
Treatment:
- Laparoscopic +/- Thoracoscopic (Hybrid) diaphragmatic hernia repair with or without mesh
- Thoracoscopic repair of hernia with or without mesh
- Open approach
Laparoscopic diaphragmatic hernia repair with or without mesh: Using multiple keyholes in the abdomen, the organs migrating into the chest are pulled back to the abdomen using different energy devices. In conditions where the organs are stuck in the chest, multiple holes are made in the chest, and the organs are pushed down into the abdomen.
Once the organs are placed into their anatomical location, the defect is defined, its size assessed, closed, and reinforced with mesh if required. The mesh, if used, is fixed with stitches and absorbable pins. In conditions where the migrating organs are not viable, removal of a portion of these might be required.
