Diaphragmatic Hernia Thoracoscopic Repair

Diaphragmatic hernia thoracoscopic repair

Small incisions are made on the chest for a camera-guided procedure to: 

• Visualize herniated organs of the thorax.
• Pump back the abdominal contents to the abdomen.
• Close the diaphragmatic hiatus.
• Stick the patch back on (sutures or mesh) as necessary.

It has great access to the defect in the chest and it minimizes the postoperative pain as opposed to open surgery.

Indications

The thoracoscopic approach is employed for the following indications:

Congenital Diaphragmatic Hernia

• Bochdalek (posterolateral) hernia
• Morgagni (anterior) hernia 

Diaphragmatic Hernia

• Blunt or penetrating injury
• Postoperative or posttraumatic diaphragmatic rupture.

Common Diaphragmatic Hernias 

Past laparoscopy/abdominal repair

Contraindications

Thoracoscopic repair is not feasible if:

• Severe respiratory distress or circulatory collapse.
• Herniate so massively that requires open repair. 
• Could not tolerate single-lung ventilation.
• Severe adhesions in chest. 

Thoracoscopic Repair Procedure

Anaesthesia

• General Anaesthesia for operative lung collapse and single-lung ventilation to facilitate visualization.

Port Placement

Usually 3-4 small cuts are made:

• Camera port
• Instrument working ports two.
• Additional ports retractable by choice.
• Thoracoscopic Exploration

Surgeon checks in herniated organs- usually:

• Stomach
• Intestines
• Liver
• Spleen

Minimization of Hernia Contents

• Light traction moves the abdominal organs back into the abdomen.

Repair of the Diaphragmatic Defect

Depending on defect size:

• Initial suture using non absorbable sutures.
• Large defects (Gore-Tex or similar) should be patched up or meshed.

Ensure No Tension

• Repair should be stress free to minimize repetition.

Chest Tube Placement

• The air and fluid can be removed by a small chest drain to enable The lung to re-expand.

Closure

• Ports are taken out and the incisions are sewn up using a suture or adhesive.

Thoracoscopic repair congenital diaphragmatic hernia

CDH is a defect in the diaphragm that can cause the diaphragm not to develop completely.  This defect allows:

• Stomach
• Intestines
• Liver
• Spleen

To herniate into the thoracic cavity. This leads to lung compression and pulmonary hypoplasia resulting in problems with breathing following birth.

Thoracoscopic CDH repair

The operative is done in a general anaesthesia under controlled ventilation.

Port Placement

Usually 3–4 small (3–5 mm) ports:

• One camera port
• Two working ports
• Additional port if required

Dilution of Herniated Organs

The protruding contents which include:

• Stomach
• Intestines
• Spleen

In some cases liver are gently re-inserted to the abdomen.

Inspection of the Defect

• The perimeters of the diaphragmatic defect are well seen. Thoracoscopy does not require the organs of the abdomen to be pulled out.

Closure of the Defect

Depending on defect size:

• Primary Closure
• Non-absorbable sutures
• Appropriate to small to medium defects.
• Patch Repair

For large defects:

• PTFE / Gore-Tex mesh
• Guarantees stress-free termination.
• Reduces recurrence risk

Lung Re-expansion

• Carbon dioxide is given out, and the lung is able to re-expand.

Chest Tube / Drain

• Installed when it is necessary to eliminate stagnant air/fluid.

Closure

• Trocar location is sutured or glued.

Pediatric thoracoscopic hernia repair

Repair of pediatric thoracoscopic hernia is an endoscopic technique employing video-assisted thoracoscopy (VATS) via several small incisions in the chest wall to correct thoracic/diaphragmatic hernia in infants and young children. It is now the standard treatment for the majority of congenital diaphragmatic hernia (CDH), Morgagni hernias, Bochdalek hernias, eventration and even a few acquired or traumatised diaphragmatic hernias. 

The methodology has less postoperative pain, faster healing, and superior visual inspection of the defect.

Minimally invasive diaphragmatic hernia repair

Minimally invasive repair of the diaphragmatic hernia involves repairing the defect using either three laparoscopic or thoracoscopic incisions instead of one open incision. It is done via minor cuts by a camera with special tools which enables the surgeon to fix herniated organs and recrete the diaphragm with minimum harm.

The method is applied to congenital, acquired and traumatic diaphragmatic hernias in both adults and children.

Minimally invasive Categories

Laparoscopic Repair

Carried out via the stomach. Ideal when:

• Abdominal manipulation is required in Herniated organs.
• There should be improved views of the abdominal contents.
• Abdominal approach is favored by the surgeons.

Thoracoscopic Repair

Performed through the chest. Ideal when:

• The defect is more available on the thorax.
• Thorax has adhesions.
• Fixation of inborn disorders such as Bochdalek CDH in children.
• They are both Video-Assisted Minimally Invasive Surgeries (MIS) that have similar success rates.

Best hospital for thoracoscopic diaphragmatic hernia repair India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Laparoscopic or thoracoscopic surgery has a minimally invasive diaphragmatic hernia repair which is safer, effective and patient friendly compared to the traditional open surgery. It has been found to be a desirable choice to congenital or acquired diaphragmatic herniae with better magnified visualization, smaller incisions, less pain and quicker recovery. Minimally invasive repair has good long-term results, reduced morbidity, and enhanced life quality when done by skilled surgeons in well-designed patients.

Thoracoscopic diaphragmatic hernia repair India GetWellGo

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FAQ

1. Does minimally invasive repair outperform open surgery?

• Yes. It leaves smaller scars, fewer cases of pain, fewer cases of infection, quicker recovery, and shorter hospitalization, with similar success rates and recurrence rates.

2. Is it possible to repair all diaphragmatic hernias in a minimal invasive way?

• Not always. Open surgery may be needed in case of very large defects, unstable patients or severe adhesions. The methodology relies on anatomy, stability, and skills of the surgeon.

3. Should meshes be used in minimal invasive repair?

• Mesh is applied in cases where the defect is massive or may not be easily closed without strain. Defects that are minimal are typically repaired by the use of sutures.

4. Is the process safe in the case of infants and children?

• Yes. Thoracoscopic or laparoscopic repair is usually carried out on stable newborns and children with good results.

5. Is there any possibility that the hernia will recur?

• Repeat is not common particularly in cases where repair procedure is tension-free and mesh is applied to defects that are large. Recommendations of follow-up imaging can be made.