From the Guidelines
Surgical repair, preferably through a laparoscopic approach, is the recommended treatment for left diaphragmatic fat hernias, especially in symptomatic patients, as it reduces morbidity and mortality rates, and improves quality of life. A left diaphragmatic fat hernia occurs when abdominal fat protrudes through a defect in the left side of the diaphragm. Treatment depends on symptoms and size, with asymptomatic small hernias often managed conservatively through regular monitoring with imaging studies like CT scans 1. Symptomatic hernias typically require surgical repair, which can be performed laparoscopically or through open surgery depending on the hernia's complexity. The surgeon will reposition the protruding fat back into the abdominal cavity and repair the diaphragmatic defect using sutures or mesh.
Some key points to consider in the management of left diaphragmatic fat hernias include:
- The use of biological and bioabsorbable meshes to reduce recurrence rates 1
- The importance of prompt surgical intervention to prevent complications such as strangulation of herniated tissue or respiratory compromise 1
- The preference for a laparoscopic approach in hemodynamically stable patients without significant comorbidities, as it facilitates early diagnosis and reduces postoperative complications 1
- The need for post-operative care to include pain management, breathing exercises, and gradual return to normal activities over 4-6 weeks, with avoidance of heavy lifting for at least 6 weeks after surgery 1
It is essential to note that the treatment of left diaphragmatic fat hernias should be individualized based on the patient's specific condition, symptoms, and overall health status. Prompt treatment is crucial to prevent complications and improve outcomes, with a focus on minimizing morbidity, mortality, and enhancing quality of life 1.
From the Research
Left Diaphragmatic Fat Hernia
- A left diaphragmatic hernia is a rare complication that can occur after thoracoabdominal interventions, such as thoracoabdominal aortic repair 2.
- The incidence of diaphragmatic hernias is unknown due to their late clinical manifestations and misdiagnosis, but they have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation 2.
- Diaphragmatic hernias can be congenital or acquired, and the usual clinical presentation may range from asymptomatic cases to serious respiratory/gastrointestinal symptoms 3.
- The diagnosis of diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray film and computed tomography scan 3.
Diagnosis and Treatment
- Computed tomography (CT) scan is the most effective imaging technique for diagnosing diaphragmatic hernias, as it shows the herniated abdominal organs together with complications such as intestinal strangulation, haemothorax, and rib fractures 4.
- Laparoscopic approach has recently gained popularity for the treatment of diaphragmatic hernias, and it has been shown to be safe and effective in several cases 5, 3.
- Robotic technology can also be used for the repair of diaphragmatic defects, as it facilitates the dissection near the esophago-gastric junction and other important adjacent structures 6.
- Surgical repair typically involves primary or patch closure of the diaphragm through an open or endoscopic abdominal or thoracic approach 3.
Specific Cases
- A case of left diaphragmatic hernia following thoracoabdominal aortic repair has been reported, where the patient presented with upper gastrointestinal bleeding and was treated with laparoscopic approach 2.
- Another case of iatrogenic left diaphragmatic hernia after laparoscopic left adrenalectomy has been reported, where the patient was successfully treated with robotic repair with mesh placement 6.