The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a ‘living document’.

Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable.A bibliographic search using major databases was performed using the terms "emergency surgery" "diaphragmatic hernia," "traumatic diaphragmatic rupture" and "congenital diaphragmatic hernia." GRADE methodology was used to evaluate the evidence and give recommendations.CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients.Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.© 2023. The Author(s).

Diaphragmatic hernias after esophagectomy are mostly asymptomatic. However, they can also manifest with severe complications and be associated with high morbidity and mortality rates. The aims of this study were to assess the incidence, predictive factors, and preferred treatment of symptomatic diaphragmatic hernias and to evaluate the role of prophylactic cruroplasty in patients after esophagectomy for carcinomas of the esophagus or gastroesophageal junction.A prospective database was used to retrospectively analyze consecutive patients who underwent esophagectomy between January 2005 and December 2015.A symptomatic diaphragmatic hernia was diagnosed in 21 (2.5%) of 851 included patients; 15 (4.3%) after 345 minimally invasive esophagectomies and 6 (1.2%) after 506 open esophagectomies (p = 0.004). Minimally invasive Ivor Lewis procedures had the highest incidence (9.4%; p = 0.002) as compared with all other procedures. Prophylactic cruroplasty did not decrease the incidence of symptomatic diaphragmatic hernias (2.1% vs 2.7%; p = 0.608). Surgical treatment consisted of cruroplasty, with reinforcement of Prolene pledgets (Ethicon, Somerville, NJ) in 11 patients. Major complications (Clavien-Dindo grade >IIIb) occurred in 3 patients, all after open repair (n = 9). Recurrences were found in 4 patients (19.0%), three after laparoscopic repair and one after open repair.The incidence of symptomatic diaphragmatic hernia after esophagectomy was 2.5%, with the highest incidence after minimally invasive Ivor Lewis esophagectomy (9.4%) as compared with other procedures. Although prophylactic cruroplasty is now the standard of care in patients undergoing minimally invasive esophagectomy, a significant lower hernia rate was not found in this study.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

To compare the safety and efficacy of minimally invasive surgery (MIS) with traditional open surgical approach for congenital diaphragmatic hernia (CDH).A literature search was performed using the PubMed database, Embase, and the Cochrane central register of controlled trials using a defined set of criteria. The outcomes, which include post-operative mortality, incidence of hernia recurrence, rates of patch use and complications, were analyzed.We investigated nine studies, which included 507 patients. All studies were non-randomized historical control trials. The MIS group had a significantly lower rate of post-operative death with a risk ratio of 0.26 [95% confidence interval (CI) 0.10-0.68; p = 0.006] but a greater incidence of hernia recurrence with a risk ratio of 3.42 (95% CI 1.98-5.88; p < 0.00001). Rates of prosthetic patch use were similar between the two groups. Fewer cases of surgical complications were found in the MIS group with a risk ratio of 0.66 (95% CI 0.47-0.94; p = 0.02).MIS for CDH repair is associated with lower post-operative mortality and morbidity compared with traditional open repair. Although rate of patch use appears to be comparable, the increased risk of CDH recurrence should not be ignored. The lack of well-controlled prospective trials still limits strong evaluations of the two surgical techniques.

Adult-congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias are uncommon entities that are often technically challenging to repair. There is growing experience with a minimal access approach to these defects.We reviewed the English-language literature using a MEDLINE search for "diaphragmatic hernia" and "laparoscopy."We found 19 case reports of laparoscopic adult-congenital diaphragmatic hernia repair. Reported complications included two enterotomies, one of which required conversion to laparotomy. We also found 11 case reports of laparoscopic chronic traumatic diaphragmatic hernia repair, with no reported complications or recurrences. Average operative time was 98 min, and average length of stay was 4.5 days. All reports claimed that there was less postoperative pain and an earlier return to full activity with the laparoscopic approach. Herein we discuss anatomy, pathophysiology, diagnosis, method of repair, and recurrence.Adult-congenital diaphragmatic hernia and chronic traumatic diaphragmatic hernia are amenable to laparoscopic repair. Although experience is still limited, laparoscopic repair appears safe and is associated with a shorter hospital stay.

Congenital diaphragmatic hernia usually presents in the neonatal period, with delayed presentation being uncommon. Traditionally repair was performed by laparotomy or thoracotomy. We have performed laparoscopic repair of a previously undiagnosed congenital diaphragmatic hernia that presented acutely in a 10-year-old male. Laparoscopic repair of late-presenting congenital diaphragmatic hernia is a safe and effective approach even in an emergency. The laparoscopic approach has advantages including reduced hospital stay, excellent visualisation of the defect even for obese patients, and improved cosmesis.

Bochdalek hernia is a type of congenital diaphragmatic hernia that mainly occurs in childhood, but is extremely rare in adults. A case report of Bochdalek hernia in a 17-year-old woman, complaining of left lateral upper abdominal pain is herein reported with a brief review of the literature. The herniated organs into the thoracic cavity in this case were the as stomach, large intestine, spleen and greater omentum which was diagnosed using computed tomography, an upper gastrointestinal double contrast study and irrigography. The patient was successfully treated by video-assisted thorachoscopic surgery (VATS) with a pushback method. The post-operating course was uneventful with minimal pain of the surgical wound. This case demonstrated the efficacy of the VATS repair for Bochdalek hernia.

Morgagni hernias are rare congenital diaphragmatic hernias that often do not become clinically significant until adulthood. The purpose of this study was to characterize the preoperative findings and describe surgical outcomes of Morgagni hernia repair based on operative approach.Charts of patients who underwent repair of a Morgagni hernia were retrospectively reviewed from 1987 to 2015. Medical records were reviewed for demographics, symptoms, comorbidities, surgical approach, hospital course, complications, and preoperative imaging.Forty-three cases were identified, 23 male and 20 female. Median age was 50.4 years, and median body mass index was 33.1 kg/m. Most common presenting symptoms were respiratory (35.7%) and gastrointestinal (28.6%). Although 83.3% of cases were newly diagnosed, none required emergent repair. Preoperative imaging demonstrated an average hernia size of 8.2 cm. Surgical approaches included laparotomy (62.8%), laparoscopic (23.3%), and thoracotomy (14%). Primary hernia repair was most common (72%). Comparing laparotomy, thoracotomy, and laparoscopic approaches, mesh repair was more common with laparoscopy (p = 0.005), operative time was shortest with laparotomy (p = 0.029), and hospital length of stay was shortest with laparoscopy (p = 0.024). The most common complication was incisional/port site hernia, with no statistical significance between surgical approaches. There was one Morgagni hernia recurrence.Morgagni hernias often present with respiratory and gastrointestinal symptoms and require repair. All cases in our series were repaired electively. Regardless of approach recurrence rate was low (2.3%) and complication rate was similar between laparoscopic, laparotomy, and thoracotomy. Given the shorter length of stay with similar recurrence rates, a laparoscopic approach is a viable option for repair of Morgagni hernia.Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Historically, there has been reluctance to use nonabsorbable synthetic mesh for repair of abdominal-wall defects in an operative field in which the presence of open bowel is accompanied by the potential for contamination. Some believe the risk of wound infection and mesh removal in this setting to be unacceptably high. The purpose of this study was to evaluate the safety and efficacy of nonabsorbable mesh used for hernia repair in the presence of a stoma or at the time of colon resection.All patients undergoing elective surgical implantation of mesh with concomitant open bowel from 1987 to 2001 were retrospectively reviewed. Computer database identified all patients undergoing parastomal hernia repair, ventral hernia repair with a stoma present, hernia repair with concomitant bowel resection, and colostomy closure with repair of hernia. No patients so identified were excluded. Follow-up was attained on all patients by chart review and telephone survey. The data was statistically analyzed by chi-squared test using a P value of <0.05 for statistical significance.Twenty-nine patients were identified as having undergone 30 elective hernia repairs using nonabsorbable mesh. The repairs were performed in the presence of a stoma or in conjunction with bowel resection. All patients received bowel preparation. Included were 11 patients undergoing parastomal hernia repair (37 percent), 14 patients undergoing ventral hernia repair in the setting of open bowel (47 percent), and 5 patients in whom mesh repair of ventral and parastomal hernias were performed simultaneously (16 percent). Hernias recurred in 13 patients (43 percent). Overall recurrence for mesh repair at a parastomal site was 63 percent; overall recurrence at an incisional hernia site was 21 percent. The risk of wound complications after mesh placement in the setting of open bowel was assessed. Wound seromas developed after surgery in four patients (13 percent). Seromas were all treated successfully by aspiration. Wound infections occurred after surgery in two patients (7 percent). Wound infection occurred exclusively in sites of parastomal repair representing 2 of 16 (13 percent) of parastomal hernia sites. Infection with fistula necessitated mesh removal in one of these two cases. No chronic sinuses were observed. Incidences of recurrence and wound infection were statistically independent of type of hernia, variety of mesh, or operative approach.After bowel preparation, nonabsorbable mesh can be used for elective repair of incisional hernia in the presence of open bowel with an expectation of minor morbidity, minimal risk of infection, and an acceptable rate of recurrence. Nonabsorbable mesh can be used for elective repair of parastomal hernia in a similar setting with a low risk of infection independent of surgical approach. Although safe, local mesh repair of parastomal hernia was, in this study, accompanied by a high rate of recurrence.

The management of large ventral hernias in patients undergoing elective colorectal surgery is controversial considering the reluctance to use a mesh during a clean-contaminated case. We retrospectively reviewed the charts of all patients having undergone at our institution any colorectal surgery along with ventral hernia repair with mesh as identified by the ICD-9 codes between 1997 and 2003. Three patients underwent incisional mesh herniorrhaphy along with elective colorectal surgery, including a right hemicolectomy, a colostomy closure, and a diverting colostomy. Hernia size varied between 330 and 1,243 cm(2). All hernias were repaired using polypropylene mesh in an onlay fashion. Average operative time was 199 min. Two patients developed postoperative wound infection, one of them requiring incision and drainage of a part of the wound. One patient developed skin necrosis of the lower aspect of his incision requiring skin excision and open wound. All open wounds granulated well and healed by secondary intention despite presence of exposed mesh. Therefore prosthetic ventral hernia repair using polypropylene mesh can be performed concomitant to elective colorectal operations, thus avoiding another laparotomy. The incidence of wound complications is, however, high but does not usually require mesh excision.

The type of mesh to be used in laparoscopic groin hernia repair has always been debatable whether to use lightweight (LW) or heavyweight (HW) mesh. The study compares the lightweight large pore mesh with HW small pore mesh in total extraperitoneal groin (TEP) hernia repair and its outcome.

This study aimed to characterize the surgical complications, especially gastroesophageal reflux disease (GERD), intestinal adhesion obstruction (IAO), and diaphragmatic hernia recurrence, in patients with congenital diaphragmatic hernia (CDH).Between January 1995 and December 2013, we determined the incidence of surgical complications and their predictors in CDH patients. We also examined whether the CDH repair and patch closure were associated with the incidence of IAO and the severity of adhesion.Seventy-four CDH survivors were evaluated. GERD occurred in 28 patients (37.8%) and recurred in 8 patients (10.8%). Stomach herniation was a risk factor for GERD, and occurred in 25 patients. IAO occurred in 13 patients (17.6%). In 240 neonatal laparotomies in the same period, the incidence of IAO was significantly higher in patients who underwent CDH repair than in patients who underwent other neonatal laparotomy (p = 0.023). Surgical time and intraoperative bleeding were significantly greater following CDH repair with an artificial patch compared with CDH repair with direct closure.Surgical complications are major sequelae in survivors of CDH repair. CDH repair and artificial patch closure were significantly associated with the incidence of IAO and the severity of adhesion.