Repair Of Diaphragmatic Defect Research Articles

Laparoscopic Surgery of an Isolated Splenic Hydatid Cyst in a 43- Year- Old Man: A Case Report

Introduction: Hydatid disease is a type of parasitic disease mainly affect the lungs and the liver and splenic hydatid cyst is a rare disease. We hereby present a rare case of splenic hydatid disease. Case report: A 43-years-old man with a history of left upper quadrant pain (LUQ) pain, anorexia, weakness, and weight loss was admitted to the surgery department in Iran. The imaging studies showed a cystic mass in the gastro-splenic ligament extending up to below the left diaphragm with adhesion to the spleen capsule and the fundus of the stomach caused focal elevation of this part of the diaphragm. A laparoscopic surgery was performed and splenic hydatid cyst with adhesion to the stomach and the left lobe of the liver and with penetration into the left hemi thorax was observed. Splenectomy, hepatectomy of the left segment of the liver, repair of diaphragmatic defect and stomach release was done. Conclusion: Splenic hydatid cyst surgery can be difficult and requires appropriate diagnostic evaluations and examination for adhesions and invasion to other organs.

Surgical correction of hydrothorax complicating pediatric peritoneal dialysis.

Hydrothorax complicating continuous cycling peritoneal dialysis (CCPD) is an uncommon event. Its presentation may occur shortly after or years after initiation of dialysis. Surgical intervention offers the advantage of direct visualization and repair of the diaphragmatic defect. Video assisted thoracoscopy surgery (VATS) has been increasingly used in identifying these defects to facilitate this repair. We present 2 pediatric cases who underwent successful direct surgical repair of diaphragmatic defects using VATS with return to CCPD. Initial approach with VATS should be strongly considered in patients in whom a lifetime change in modality has significant repercussions.

Acute gastric volvulus through an unsuspected diaphragmatic hernia

Abstract Acute gastric volvulus occurs when the stomach undergoes torsion in the thoracic cavity. It may result from an accompanying enlargement of the hiatus or a missed congenital diaphragmatic hernia (CDH). We describe a 12-year-old girl who presented to our emergency department with acute epigastric pain and non-bilious vomiting. An incidental finding of diaphragmatic hernia with hugely dilated stomach was diagnosed by plain X ray, Ultrasound (US) and Computed tomography (CT) abdomen with oral contrast. She underwent laparotomy and gastric volvulus was found. Reduction of the viscera to the abdominal cavity and repair of diaphragmatic defect was done. She recovered with accepted general condition and was discharged five days later.

A newly designed bioabsorbable substitute for the treatment of diaphragmatic defects

Earlier studies have investigated the suitability of various materials and autologous grafts for the repair of diaphragmatic defects. Our group investigated the feasibility of using an artificial diaphragm (AD) to repair wide diaphragmatic defects. Twelve pigs were laparotomized and, in each pig, a defect was fashioned by resecting a round 8-cm diameter hole in the left diaphragm. Next, the defect was repaired by implanting an AD. The animals were relaparotomized 8 or 24 weeks after implantation for gross, histological and radiological observation of the implanted sites. All recipient animals survived until killing for evaluation. Chest X-ray examinations showed no differences between the preoperative diaphragms and the grafted diaphragms at 8 and 24 weeks after implantation. At 8 weeks after implantation, the implanted sites exhibited fibrous adhesions to the liver and lungs without deformities or penetrations. Parts of the surface tissue at the graft sites had a varnished appearance similar to those of the native diaphragm. Histology performed at 8 weeks detected no trace of the ADs in the graft sites; however, numerous inflammatory cells and profuse fibrous connective tissue were observed. At 24 weeks after implantation, no differences were found in the thorax between the areas with the grafts and the unaffected areas. Histology of the graft sites in the thorax confirmed growth of mesothelial cells similar to that observed in the native diaphragm. Artificial diaphragms can be a novel substitute for diaphragmatic repair.

Descrição morfológica do diafragma do sagui-de-tufo-branco (Callithrix jacchus)

O músculo diafragma, encontrado apenas nos mamíferos, é o principal músculo no processo respiratório, servindo de fronteira entre as cavidades torácica e abdominal. Sua importância também ganha destaque em pesquisas realizadas no âmbito dos enxertos, empregando-se diversos tipos de membranas biológicas para o reparo de defeitos diafragmáticos, os quais podem gerar hérnias diafragmáticas. Apesar de muitos estudos já conduzidos para com os primatas não humanos, especialmente no que tange a espécie do novo mundo Callithrix jacchus (Sagui-de-tufo-branco), oriundo do nordeste brasileiro, as pesquisas envolvendo o uso do diafragma em tal espécie é inexistente. Deste modo objetivou-se caracterizar a morfologia e a biometria do diafragma na espécie Callithrix jacchus de ambos os sexos, analisando possíveis divergências estruturais entre machos e fêmeas. Para tal foram utilizados quatros animais, 2 machos e 2 fêmeas, adultos, que vieram a óbito por causas naturais, provenientes de um criadouro comercial. Após fixação em solução de formaldeído 10% os animais foram devidamente dissecados para fotodocumentação e em seguida o diafragma coletado para efetuação da biometria (comprimento e largura) com o uso de um paquímetro e para o processamento histológico por meio da coloração de hematoxilina-eosina e tricrômio de masson, da porção muscular. As mensurações feitas permitiram concluir que não houve diferenças signifcativas entre machos e femeas. A topografia e a presença de três aberturas (forame da veia cava caudal, hiato aórtico e esofágico) na extensão do diafragma corroboram com descrições na literatura classica para outros mamíferos. A presença de um centro tendíneo em "V" difere do encontrado para animais como o peixe-boi e porquinho-da-india, mas é similar ao encontrado para o gambá-de-orelhas-brancas e rato albino. No que diz respeito aos achados histológicos conclui-se que as fibras musculares estão dispostas de forma organizada, apresentam diâmetro grande e núcleos basais, tendo, portanto, características similares do músculo estriado esquelético tanto nos animais machos como nas fêmeas.

Omentopexy for the repair of diaphragmatic defect and adhesion assessment of viscera to propylene mesh- an experimental study in rabbits

Background The use of synthetic mesh for the repair of major congenital diaphragmatic hernia may cause visceral adhesion to the prosthesis and ongoing complications. In the present study, the use of propylene mesh for the repair of diaphragmatic hernia and the role of omentopexy in elimination of visceral adhesion to repair site has been evaluated.

Laparoscopic repair of post-esophagectomy diaphragmatic hernias using human acellular dermal matrix

Diaphragmatic hernias occur in up to 2% of patients after esophagectomy with gastric pull-up, and the surgical repair in the setting of a previous esophagectomy is a challenge with high complication rates, in particular with regards to the gastric conduit and its critical vascular supply. We describe two cases and the technique of minimally invasive, laparoscopic repair of diaphragmatic defects with organ herniation after esophagectomy using absorbable human acellular dermal matrix.

Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment.

Catamenial pneumothorax is defined as spontaneous pneumothoraces occurring within 72 h before or after onset of menstruation. It is rare but clinical index of suspicion should be high in ovulating women with spontaneous pneumothoraces. The mechanism is unclear but is thought to involve pre-existing or acquired diaphragmatic defects and endometrial implants. Traditional therapy involving hormonal treatment or surgical pleurodesis alone is associated with high rates of recurrence. A series of four patients with catamenial pneumothorax managed at our institution is presented to highlight the condition to various surgical specialties to whom it may present, and to emphasise the importance of both surgical and hormonal interventions in preventing recurrence. Each patient underwent video-assisted thoracoscopic inspection of the diaphragm, mechanical pleurodesis and, most importantly, repair of diaphragmatic defects with an artificial mesh. Surgical treatment was strictly followed by a course of gonadotrophin-releasing hormone analogue therapy in three patients, with no recurrence to date (longest follow-up 45 months). The fourth patient suffered a postoperative recurrence when hormonal treatment was delayed for 6 weeks, stressing the importance of hormonal treatment in conjunction with surgery.

The Technical Aspects of Laparoscopic Repair of Diaphragmatic Defects in Neonates and Infants

Purpose: To present our experience with minimally invasive surgery for central and left-sided diaphragmatic defects in the neonate and infants.Methods: For congenital diaphragmatic hernia (CDH), the laparoscopic technique is helped by a port position well out in the left flank, a hitch stitch to hold the posterior muscle shelf forward during the repair, and the patient positioned with the head up and the left side rotated well forwards. For hemi-diaphragmatic palsy, in addition, two rows of plication could be achieved only after the left lobe of the liver had been detached from the diaphragm. For Morgagni hernia, the defect was closed with muscle-to-muscle sutures, with the patient supine.Results: Four patients, ranging in age from a neonate to 18 months, underwent successful primary laparoscopic repair of one Morgagni hernia, one hemi-diaphragmatic palsy, and two diaphragmatic hernias. Presenting symptoms ranged from minor, to one neonate requiring ventilatory support. The maximum length of stay after su...

Catamenial pneumothorax: retrospective study of surgical treatment

Background Catamenial pneumothorax is a rare entity characterized by recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is also associated with a high rate of postoperative recurrence. The aim of this study was to discuss the etiology and to determine the optimal surgical treatment of this entity. Methods From December 1991 to September 2000, 10 patients with catamenial pneumothorax were treated at our institution. Median age at time of operation was 37 years (range, 21 to 44 years). We retrospectively evaluated the pathologic findings, the operation performed, and the results in all patients. The mean follow-up was 55.7 months. Results Pleurodesis alone was performed in 5 patients and an associated diaphragmatic procedure was performed in 5 patients. In 5 patients, no diaphragmatic anomaly was discovered: 3 experienced one or more recurrences and all still suffer from chronic catamenial chest pain. Hormonal therapy temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5 patients surgical pleurodesis was associated with the repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence (n = 0/5, p = 0.0016) and no subsequent catamenial chest pain. Conclusions The postoperative outcome is influenced by the diagnosis of diaphragmatic defects with or without endometriosis. Surgical treatment should be accomplished during menstruation for an optimal visualization of pleurodiaphragmatic endometriosis. Because diaphragmatic lesion is frequent and may be occult, we propose the systematic coverage of the diaphragmatic surface by a polyglactin mesh to prevent catamenial pneumothorax recurrence even when the diaphragm appears normal.

Reparação do diafragma de cães com segmento muscular homólogo ortotópico conservado em solução supersaturada de açúcar

O uso de enxerto muscular homólogo conservado em solução supersaturada de açúcar a 300% foi pesquisado no músculo diafragma de cães. Foram utilizados 12 cães adultos, quatro machos e oito fêmeas, sem raça definida, com peso entre 9 e 18kg, para confecção de um defeito diafragmático na porção muscular, com dimensões de 4,0 × 4,5cm, seguido da implantação de um segmento de músculo diafragma homólogo. Seis cães foram observados por um período de 30 dias de pós-operatório e seis por 60 dias, quando foram reoperados para observação macroscópica e coleta de amostra para avaliação histológica. Nos animais do grupo de 30 dias de pós-operatório verificou-se substituição parcial e nos de 60 dias, substituição total da porção muscular do diafragma por tecido de granulação, o que permitiu o restabelecimento completo do diafragma por meio de firme inserção. O segmento de músculo diafragma homólogo conservado em solução supersaturada de açúcar a 300%, em temperatura ambiente, pode ser utilizado para reparação de defeitos diafragmáticos, uma vez que é substituído por tecido conjuntivo fibroso, sem apresentar sinais clínicos nem histológico de rejeição.

Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects

Recent reports indicate a significant incidence of gastroesophageal reflux (GER) and other nonpulmonary problems after the repair of congenital diaphragmatic defects. Reports of follow-up through adulthood are few and based on a small number of patients. From 1948 to 1982, 107 of 164 patients (65%) treated at the authors' institution survived after repair of congenital diaphragmatic hernia or eventration. Sixty of the 107 survivors (56%) (mean age, 29.6 years; SD, 9.0 years) were interviewed and examined clinically. Forty-one of the sixty (68%) underwent upper gastrointestinal endoscopy. Early postoperative GER was recorded for 11 of the 60 patients (18%). Two of them underwent fundoplication because of an esophageal stricture. At the time of the follow-up study, 38 of the 60 (63%) reported symptoms suggestive of GER. Endoscopic or histological GER (esophagitis, Barrett's esophagus) was present in 22 of 41 patients (54%). No significant correlation between the intial severity of the diaphragmatic defect or neonatal postoperative problems and the late GER could be verified. Intestinal obstruction requiring hospital admission occurred in 12 of the 60 patients (20%), eight of whom had surgical treatment between 1 month and 20 years after repair of the diaphragmatic defect. GER and intestinal obstruction are common among patients who have undergone repair of a congenital diaphragmatic defect. Investigations for GER should be performed routinely during the follow-up of these patients.

Surgical management of diaphragmatic defects in the newborn infant: A report of twenty infants each less than one week old (1956–1961)

This is a preliminary report on experiences derived from the surgical management of twenty infants born with diaphragmatic defects, each less than one week old at the time of operation. The appropriate emergency preoperative management has been outlined. The surgical technique for closure of large and small diaphragmatic defects has been described briefly, and a more detailed emphasis has been given to the construction of an intentional ventral hernia. Finally, details of postoperative management of the gastrostomy and chest tube of parenteral fluid therapy and of oral alimentation in such patients have been presented briefly. Employing ventral hernia as an adjunctive procedure in the repair of diaphragmatic defects in infants less than one week old has shown that the mortality rate can be lowered significantly from seventy-five per cent, in comparable infants (Group I) in whom primary abdominal wall closure is achieved, to less than 16 per cent, in infants (Group II) in whom a ventral hernia is employed. The mortality rate of less than 16 per cent for the repair of congenital diaphragmatic defects in the newborn infants in Group II is believed to be the lowest reported to date in the literature and should be attributed in great measure to the utilization of ventral hernia.

Polyvinyl Formalinized (Ivalon) Sponge in the Repair of Diaphragmatic Defects

Diaphragmatic hernias can usually be surgically repaired without much difficulty by simple approximation of the edges of the defect. In a small percentage of cases, however, the tissue available for repair is inadequate or insufficient. When this occurs, ancillary surgical procedures are necessary to obliterate the defect. Shifting the diaphragm cephalad,¹mobilization of the chest wall by thoracoplasty,²or limited rib resection,³may be employed to provide sufficient tissue to approximate the edges of the defect. This increases the magnitude of the procedure and may result in deformity. The experimental use of homologous tissue, such as fascia lata, has also been reported.⁴ In 1951, Monahan⁵repaired a congenital eventration of the diaphragm, using tantalum mesh. This material tends to fragment after several months, resulting in weakening of the repair or recurrence of the defect. Nylon net has been used experimentally in dogs by Adler.⁶