From the Guidelines
The treatment of diaphragmatic hernia should be approached with prompt surgical intervention, preferably via a laparoscopic approach in hemodynamically stable patients, as it reduces postoperative complications and facilitates early diagnosis of small diaphragmatic injuries. The management of complicated diaphragmatic hernia in the acute setting is a potentially life-threatening condition that requires immediate attention 1. According to the World Journal of Emergency Surgery, a CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated diaphragmatic hernia 1.
Key Considerations
- Appropriate preoperative assessment is crucial for clinical success 1
- Biological and bioabsorbable meshes are recommended for repair as they reduce recurrence 1
- Open surgery should be reserved for situations where skills and equipment for laparoscopy are not available, or if the patient is hemodynamically unstable 1
- Damage Control Surgery is an option in the management of critical and unstable patients 1
Treatment Approach
The treatment approach should prioritize the patient's stability and the availability of resources. In general, laparoscopic repair is the preferred technique for stable patients without significant comorbidities. However, open surgery may be necessary in certain situations, such as when the patient is hemodynamically unstable or when exploratory laparotomy is needed 1.
Postoperative Care
Postoperative care should focus on pain management, respiratory support, and monitoring for complications such as recurrence, infection, or respiratory compromise 1. Early surgical intervention is crucial to prevent complications like strangulation of herniated organs, respiratory distress, and long-term pulmonary hypoplasia in congenital cases.
From the Research
Diaphragmatic Hernia Treatment Options
- Diaphragmatic hernia can be treated using various approaches, including open, laparoscopic, and combination methods 2, 3, 4, 5, 6
- Laparoscopic approach has gained popularity in recent years due to its safety, efficacy, and outcomes 2, 3, 5, 6
Laparoscopic Repair
- Laparoscopic repair involves primary or patch closure of the diaphragm through an endoscopic abdominal or thoracic approach 2, 3, 4, 5, 6
- This approach can be used for both congenital and acquired diaphragmatic hernias 3, 5, 6
- Laparoscopic repair can be performed using different techniques, including tension-free technique and resection of the hernia sac with closure of the defect and reinforcement by prosthesis 4
Indications for Laparoscopic Repair
- Laparoscopic repair may be feasible for elective surgery and in emergency settings, taking into account hemodynamic stability and associated injuries 3
- The decision to use laparoscopic repair depends on the type of diaphragmatic hernia, patient's condition, and surgeon's experience 3, 4, 5, 6
Outcomes and Complications
- Laparoscopic repair of diaphragmatic hernias has been shown to be safe and effective, with low complication rates and no recurrences in some studies 2, 3, 5
- However, complications such as postoperative cardiac tamponade, prolonged gastric ileus, and recurrence can occur 4, 5, 6
- The choice of prosthesis and management of the hernial sac are still controversial topics in laparoscopic repair of diaphragmatic hernias 6