From the Research
Repair of an asymptomatic anterior central diaphragmatic hernia should be performed electively after appropriate preoperative evaluation, typically within 3-6 months of diagnosis, as supported by the most recent and highest quality study 1. The optimal timing balances the risk of potential complications against the benefits of surgical preparation. Patients should undergo a thorough cardiopulmonary assessment, including pulmonary function tests and cardiac evaluation, prior to surgery.
Key Considerations
- The procedure is typically performed using a minimally invasive approach (laparoscopic or thoracoscopic) when feasible, though open repair via laparotomy or thoracotomy may be necessary for complex cases, as noted in 2 and 1.
- Mesh reinforcement is often utilized to reduce recurrence rates.
- Postoperatively, patients require pain management, early mobilization, and respiratory therapy to prevent pulmonary complications.
Rationale
The rationale for repairing even asymptomatic hernias is to prevent potential future complications such as incarceration, strangulation, or respiratory compromise, which can occur suddenly and carry significant morbidity and mortality, as highlighted in 3 and 4.
Special Considerations
However, in patients with significant comorbidities or advanced age, a watchful waiting approach with regular imaging surveillance may be considered after careful risk-benefit assessment, as suggested in 3 and 5.
Procedure Details
The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands, with good postoperative recovery and low recurrence rates, as demonstrated in 1.
Outcomes
All patients had good postoperative recovery and went home early with normal follow-up, and were followed up for 2 years, as reported in 1.