Diaphragmatic Defect Research Articles (Page 1)

Challenges and controversies in the surgical management of Congenital Diaphragmatic Hernia.

Long-Term Pulmonary Function Outcomes in Children with Pulmonary Hypoplasia.

The ex-utero intrapartum treatment (EXIT) strategy for congenital diaphragmatic hernia in a twin pregnancy: A case report and literature review.

A rare variant of dysontogenesis of the embryonic diaphragm in children is Morgagni–Larrey hernia and hypoplasia of the muscular layer of the diaphragm. The low frequency of these malformations, which ranges from 1 : 2000 to 1 : 4000 newborns, and the nonspecific clinical manifestations of the disease explain the limited experience of specific specialists in diagnostics, features of surgical treatment, and early postoperative rehabilitation of children with these anomalies. Aim. To analyze the features of the clinical course, diagnosis, and surgical treatment of a rare diaphragmatic malformation in a child, Morgagni–Larrey hernia combined with hypoplasia of the right diaphragmatic dome, using an original case as an example. Clinical case. A 13-year-old boy K., who was undergoing inpatient treatment in the surgical department of Zaporizhzhia Regional Children’s Clinical Hospital, was diagnosed with a large congenital hernia of the anterior part of the right diaphragmatic dome based on clinical complaints and results of laboratory and instrumental examinations. Following a comprehensive clinical and laboratory evaluation, the child underwent surgery, including right-sided anterolateral thoracotomy, plastic repair of the right diaphragmatic dome, removal of the congenital Morgagni–Larrey hernia with defect repair using a polypropylene anti-adhesive mesh (Peters Surgical, France), and pleural cavity drainage using the Bülau technique. Intraoperatively, a large congenital hernia of the anterior diaphragm (measuring 17 × 15 × 12 cm) and hypoplasia of the right diaphragmatic dome muscular part were identified. The hernial sac contents were adherent to the greater omentum. Postoperative diagnosis: congenital diaphragmatic defects, including hypoplasia of the right diaphragmatic dome and Morgagni–Larrey hernia. The postoperative period was uneventful with the wound healing by primary intention. Pleural cavity drainage was removed on day 3, and the patient was discharged home on day 10. Follow-up examinations at 6 months and 1 year revealed the patient remained asymptomatic with no complaints or functional impairments. Conclusions. Morgagni–Larrey diaphragmatic hernia combined with hypoplasia of the right diaphragmatic dome remained asymptomatic in the patient for an extended period. The gradual increase in hernia size led to compression of the right lung and nonspecific clinical manifestations, including coughing attacks. The most effective diagnostic method, beyond chest radiography, was computed tomography. The transthoracic surgical approach was the most appropriate, enabling the elimination of the significant hernial process and plastic repair of the right diaphragmatic dome.

SummaryA 4‐year‐old Thoroughbred gelding was presented with a history of severe colic signs that were non‐responsive to non‐steroidal anti‐inflammatory drugs. During initial evaluation, distended small intestine was observed, together with continued colic signs and a serosanguinous abdominocentesis sample. It was therefore elected to perform an exploratory laparotomy to ascertain and resolve the source of colic. Intraoperatively, a 2 cm horizontal defect was located at the junction between the diaphragm and the left 12th rib, midway between the dorsal and ventral body walls. One metre of small intestine was entrapped within the thoracic cavity. The diaphragmatic defect was digitally extended to 6 cm to allow safe exteriorisation of the intestine. The resulting defect extended from just left of midline to the body wall; the defect was sutured closed using 4 M polyglactin 910 in a simple continuous pattern, utilising forwarder and Aberdeen self‐locking knots. Subsequently, the horse also underwent a jejunoileostomy. The horse progressed well post‐operatively, with the exception of an incisional infection. Repeat thoracic evaluation 2 weeks post‐operatively and again 6 months post‐operatively revealed no evidence of reoccurrence.

Congenital Diaphragmatic Hernia (CDH) is a life-threatening condition characterised by the herniation of abdominal organs into the thoracic cavity through a diaphragmatic defect, leading to pulmonary hypoplasia and Persistent Pulmonary Hypertension (PPHN). This case report highlights the perioperative anaesthetic management of a 4-day-old, 2.5 kg neonate with left-sided CDH and severe pulmonary hypertension undergoing surgical repair. The neonate was intubated immediately after birth due to respiratory distress and was managed with Synchronised Intermittent Mandatory Ventilation (SIMV). Cardiopulmonary support was provided using infusions of milrinone, sildenafil, and dobutamine. After stabilisation, surgical repair was performed on day four of life. Anaesthesia was induced with sevoflurane and oxygen under spontaneous respiration to minimise barotrauma, transitioning to controlled anaesthesia with atracurium following bowel exteriorisation. A caudal epidural catheter was placed for intraoperative and postoperative analgesia using 0.1% ropivacaine. Following surgery, the neonate remained on SIMV with gradual weaning from respiratory support, achieving successful extubation by postoperative day three. Regular monitoring and a multidisciplinary approach ensured stabilisation and optimal recovery. This case underscores the importance of comprehensive perioperative strategies in managing neonates with CDH. Key measures include careful preoperative stabilisation, use of spontaneous ventilation during anaesthesia induction to reduce lung trauma, and effective analgesia using caudal epidural techniques. Combining these interventions with cardiopulmonary support can significantly improve outcomes in this high-risk population.

Morgagni hernia is a rare form of congenital diaphragmatic hernia that represents 2% to 5% of all diaphragmatic hernias, with an estimated incidence of 1 in 2000 to 1 in 5000 live births (1,2). It was described by Giovanni Battista Morgagni in 1769 (3). It results from the failure of fusion of the anterior pleuroperitoneal membrane with the sternum and costal cartilages (4). The contents of the hernia sac may include omentum, colon, stomach, and even liver (5). The diagnosis is primarily made through computed tomography (6). A 64-year-old female patient with a history of arterial hypertension and diabetes mellitus presented with a clinical course of six days characterized by abdominal distension, right hypochondrium pain, nausea, vomiting, and decreased bowel transit. Physical examination revealed abdominal distension with tympanism and tenderness on deep palpation in the right hypochondrium. CT confirmed an anterior right diaphragmatic defect measuring 32 mm, with herniation of abdominal fat and the hepatic angle of the colon, which was compressed causing intestinal obstruction. Exploratory laparotomy was performed, identifying a Morgagni hernia with a 4 × 3 cm defect and a hernia sac measuring 10 × 5 cm containing transverse colon and necrotic omentum. Necrotic omentum resection, reduction of the herniated contents, sac ligation, and primary closure of the diaphragmatic defect were performed. A comprehensive review of 17 indexed articles published between 2020 and 2025 was conducted, consolidating information on epidemiology, clinical presentation, diagnostic methods, and surgical management of this pathology. It is concluded that surgical repair should be indicated in all cases, preferring the laparoscopic approach when possible, using mesh in defects greater than 4 cm, and individualizing sac resection (8–17). This article provides an updated, evidence-based perspective on the management of Morgagni hernia in adults

Porous diaphragm syndrome (PDS) is a rare and underrecognized condition characterized by the transdiaphragmatic migration of peritoneal contents into the pleural cavity through defects in the diaphragm, most often affecting the right hemidiaphragm. It is commonly associated with hepatic hydrothorax, peritoneal dialysis-related hydrothorax, and peritoneal carcinomatosis. Despite its anatomical simplicity and the availability of effective surgical treatment, PDS is frequently misdiagnosed, leading to repeated pleural drainage, inappropriate therapies, and treatment delays. This review synthesizes evidence from the past 25 years, drawing from PubMed, Scopus, and Web of Science, with a focus on clinical presentations, diagnostic methods, surgical management, and long-term outcomes. PDS most often presents as recurrent right-sided pleural effusion in cirrhotic or dialysis-dependent patients. Diagnostic approaches include pleural fluid analysis, CT peritoneography, peritoneal scintigraphy, and video-assisted thoracoscopic surgery (VATS), which also serves as the definitive therapeutic modality. VATS enables the direct visualization and repair of diaphragmatic defects with high success rates and low recurrence rates. Surgical correction often allows peritoneal dialysis to be resumed, while cirrhotic patients may benefit from transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation for long-term control. PDS should be considered in all cases of unexplained, recurrent pleural effusion in patients with underlying intra-abdominal pathology. Early recognition and multidisciplinary intervention, especially through thoracoscopic techniques, are key to improving outcomes and reducing recurrence.

OBJECTIVESCatamenial pneumothorax is an underdiagnosed condition, despite accounting for up to 35% of spontaneous pneumothoraces in young women. This study aims to delineate the most appropriate surgical treatment comparing a 15-year experience of five European centres.METHODSA European multicentre retrospective cohort study was conducted. We evaluated all the spontaneous pneumothoraces occurring in women of childbearing age. We included all the cases with evidence of diaphragmatic alterations. Thirty-six patients were included and evaluated. We compared their surgical treatment, in-hospital variables and rate of recurrence.RESULTSThe surgical approach was thoracoscopic for 34 patients and open for 2. Thirty patients presented diaphragmatic involvement. According to the diaphragmatic treatment the patients were divided into three groups: prosthetic replacement (19; 15 synthetic grafts and 5 biological); surgical repair (6; 4 direct sutures and 2 stapling); and no treatment (11). All patients received pleurodesis (6 mechanical, 15 chemical and 3 a combination of these). Median follow-up was 54 months, during which 15 recurrences occurred. Despite no statistically significant difference between the treatment groups, the relapse rate slightly favoured the prosthetic group (26.3% vs 56.8%, P = 0.09) and direct diaphragmatic repair had a significantly higher conversion rate compared with prosthetic replacement (21% vs 100%, P = 0.004). Notably, none of the patients with biological mesh relapsed during the follow-up.CONCLUSIONSOur data suggest treating all diaphragmatic defects with thorough attention. Moreover, prosthetic replacement resulted in a safe and effective procedure and biological mesh should be preferred in this setting, showing excellent postoperative and long-term results.CLINICAL REGISTRATION NUMBEROur institutional review board granted approval and waived the requirement for specific informed consent for this retrospective analysis.

We describe two uncommon cases of hiatal hernias in children, including the rare simultaneous presence of a hiatal hernia and a Morgagni hernia.Case 1-An early childhood girl presented to the emergency department with dyspnoea. A chest X-ray suggested a significant diaphragmatic hernia, further characterised by CT, which revealed a complex diaphragmatic defect involving both a hiatal hernia and a Morgagni hernia. The child underwent successful surgical correction with a good outcome.Case 2-A girl in her early childhood presented to the emergency department with a 2-week history of intermittent fever. Imaging studies, including a chest X-ray and CT scan, revealed a large sliding gastric hernia through the oesophageal hiatus. The child underwent surgery, resulting in a favourable outcome.In both cases, the diagnosis was incidental, underscoring the importance of early recognition and a high index of suspicion to ensure optimal outcomes.

Pleuroperitoneal communication affects 1.6%-10% of continuous ambulatory peritoneal dialysis (PD) patients and often leads to discontinuation of peritoneal dialysis. In pleuroperitoneal communication, an important aspect is not only the diagnosis but also the detection of the diaphragmatic defect. Traditional methods have often failed to detect small defects, which contributes to the recurrence of pleuroperitoneal communication. We present three cases of intractable diaphragmatic defects in pleuroperitoneal communication, successfully localized and treated using indocyanine green (ICG) fluorescence staining of peritoneal dialysate, visualized with an infrared camera. After detecting the defect, surgical repair involved defect plication and the application of talc for pleural adhesion. This approach enabled immediate and successful on-site repair, allowing all patients to resume peritoneal dialysis post-surgery. Even the smallest diaphragmatic defects were accurately identified using ICG fluorescence dye dissolved in peritoneal dialysate. This case series demonstrates that ICG fluorescence staining enhances the diagnosis and treatment of pleuroperitoneal communication by improving defect localization. Our protocol shows promise in increasing diagnostic accuracy, reducing recurrence rates, and helping patients maintain their preferred dialysis modality.

Abstract Introduction Morgagni hernias are the most common congenital defect in the anterior parasternal portion of the diaphragm. Although they are rare in the adult population, they can present with a wide range of symptoms, from asymptomatic cases to those with clinically significant manifestations. This case report describes an adult patient with a Morgagni hernia who was successfully managed with laparoscopic surgery. Case Report A 73-year-old female presented with longstanding symptoms of exertional shortness of breath, epigastric pain, and constipation. An ultrasound revealed gallbladder stones, and the patient was scheduled for an elective laparoscopic cholecystectomy. During the procedure, a large anterior diaphragmatic hernia containing bowel was identified, prompting abandonment of the surgery to allow for further evaluation. A postoperative CT scan confirmed the presence of a large Morgagni hernia. The patient was subsequently scheduled for elective laparoscopic repair. Intraoperatively, a right anterior diaphragmatic defect was identified, with herniation of both the small and large bowel through the defect. The falciform ligament was divided to provide better exposure. The hernia contents were reduced, and the hernia sac was dissected, reduced, and excised. The diaphragmatic defect was closed using interrupted Ethibond sutures, and a 10x15 cm composite Parietex mesh was secured with absorbable tackers. The patient had an uneventful postoperative recovery and was discharged a few days later. Follow-up at six months postoperatively showed significant improvement in her symptoms. Conclusions Laparoscopic mesh repair of Morgagni hernias, including excision of the hernia sac, is a feasible and effective option in the hands of an experienced laparoscopic surgeon.

Adult Bochdalek hernias represent a rare clinical entity that often presents diagnostic challenges due to their non-specific symptomatology. We report the case of a 42-year-old male who presented with acute abdominal pain and was found to have a left-sided Bochdalek hernia with strangulated small bowel. The patient underwent a successful laparoscopic repair using right lateral decubitus positioning, which facilitated optimal access to the diaphragmatic defect. The herniated bowel was reduced and found to be viable, and the defect was closed primarily with mesh reinforcement. This case highlights the importance of maintaining a high index of suspicion for diaphragmatic hernias in adults with vague abdominal and respiratory symptoms, the value of prompt imaging in establishing the diagnosis, and the efficacy of minimally invasive surgical techniques with innovative patient positioning for definitive management. The patient recovered well, with complete resolution of symptoms and no recurrence at the 4-year follow-up.

Risk Factors of Undescended Testis in Congenital Diaphragmatic Hernia: A Multicenter Study in Japan.

The presented case study demonstrates an example of successful treatment for a teenage patient who underwent subtotal resection of the diaphragm due to pleural empyema, resulting in the eventration of abdominal organs into the left hemithorax, the innovative technique used involved diaphragm plastic surgery using parietal pleural leaves and mesh implant, leading to positive outcomes.

The presented case study demonstrates an example of successful treatment for a teenage patient who underwent subtotal resection of the diaphragm due to pleural empyema, resulting in the eventration of abdominal organs into the left hemithorax, the innovative technique used involved diaphragm plastic surgery using parietal pleural leaves and mesh implant, leading to positive outcomes.

Congenital diaphragmatic hernia is a rare condition characterized by the development of a defect in the diaphragm during early embryogenesis. For the most severe cases, when the diaphragmatic defect is large, the gap is currently closed by a prosthetic patch made of e-PTFE (Gore-Tex) materials, which lack sufficient elasticity, causing early rupture of stitches and subsequent hernia recurrence. In this study, we introduce a novel thermoplastic polyurethane membrane designed to accommodate the child's growth. This film/fiber bilayer membrane, produced in a single continuous electrospinning process by varying the flow rate, exhibits a smooth surface to prevent adhesion of the tissues on the abdominal side and a rough surface to promote adhesion of the diaphragm muscle on the thoracic side. Mechanical properties of the membrane were evaluated under various deformation modes, including uniaxial tensile tests and equibiaxial tensile tests by the bubble inflation technique. We demonstrated the ability to tune the elastic modulus by adjusting the thickness of the film and fibers, achieving greater stretchability than specified for supporting child growth and respiration both in uniaxial and inflation tests. Moreover, invitro biological tests showed that the membrane promotes cellular colonization without pro-inflammatory effect, making it a promising candidate to replace the currently used prosthesis.

Recurrence in congenital diaphragmatic hernia: A multicenter, postdischarge pilot study.

BackgroundPeritoneal dialysis (PD)-related pleuroperitoneal communication is strongly associated with PD discontinuation. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising therapeutic approach. However, there are still challenges in detecting diaphragmatic defects under conventional thoracoscopy, and the repair methods vary significantly.MethodsWe have developed an intervention protocol for pleuroperitoneal communication that includes single-port VATS utilizing near-infrared fluorescence with indocyanine green, as well as the management of perioperative kidney care and PD reinitiation. Patients who underwent VATS for pleuroperitoneal communication repair from September 2022 to March 2024 were identified at a single center. The procedures and outcomes were evaluated, and the success rate of PD resumption was compared with that of a historical cohort treated with non-surgical therapies.ResultsA total of 6 patients underwent VATS. The age was 48.7 ± 11.8 years, 2 were female, and the PD vintage was 8.7 (2.0-28.4) months. Non-dialysis therapy (n = 4) or temporary hemodialysis (n = 2) was prescribed during PD suspension. Fluorescence thoracoscopy identified diaphragmatic defects in all patients, including lesions that were unrecognizable under white light. Mechanical pleurodesis by direct suture of the defects with local mechanical reinforcement was performed. All patients reinitiated PD 15-30 days postoperatively, with no recurrence during a follow-up of 17.0 ± 6.4 months. The success rate significantly exceeded that in the patients who underwent PD suspension or chemical pleurodesis (100% vs. 29%, p = 0.005).ConclusionsThe minimally invasive VATS integrating fluorescence with indocyanine green and pleurodesis with multiple mechanical reinforcements, along with appropriate perioperative care and an incremental approach to resume PD, was a reliable treatment for PD-related pleuroperitoneal communication.

Ensuring the security and reliability of lithium-ion batteries necessitates the development of a robust methodology for detecting defects in battery separators during production. This study initially uses data augmentation techniques in the data processing phase, followed by the utilization of the weighted random sampler method for sampling. Additionally, the dataset is partitioned using the Stratified K-Fold cross-validation method to tackle imbalanced sample data. Subsequently, an ensemble of object detection algorithms involving Faster Region Convolutional Neural Network and RetinaNet is developed. The ensemble method employs a voting mechanism to ascertain the most accurate predictions and utilizes the Adaptive Delta optimization algorithm with adaptive learning rates. This algorithm adjusts the learning rate based on parameter change rates, eliminating the requirement for setting an initial learning rate to ensure result convergence. Finally, a model fine-tuning technique using pre-training transfer learning is applied to improve the detection performance of the ensemble model. Experimental results show that the improved methodology demonstrates a 16.26% increase in recall, a 7.05% improvement in precision, an 11.83% rise in balanced F Score, and a 0.23 increase in the area under the Receiver Operating Characteristic curve. The study results indicate that the proposed method is an effective and accurate approach to detecting defects in lithium-ion battery separators.