Traumatic Diaphragmatic Hernia: Safety and Efficacy of a Minimally Invasive Approach: Case Report
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SURGERY
Traumatic Diaphragmatic Hernia: Safety and Efficacy of a Minimally Invasive Approach: Case Report Katherine Ott 1
&
David Odell 1 & Jonah Stulberg 1
Accepted: 16 September 2020 # Springer Nature Switzerland AG 2020
Abstract Missed diagnosis of traumatic diaphragmatic hernia is a known complication of blunt trauma as the diagnosis can be difficult to ascertain acutely. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently, open primary repair was the standard of care with few centers attempting laparoscopic repair for select patients. The objective of this study was to evaluate the safety, technical feasibility, and clinical outcomes for minimally invasive repair utilizing the DaVinci Robotic platform for traumatic diaphragmatic hernia repair. Robotic repair was performed on a patient who presented with a large diaphragmatic hernia 9 years after blunt trauma. The procedure was recorded, technique detailed, and clinical outcomes assessed. There were no significant adverse events noted. After 1 year, the patient is doing well with no complaints, no evidence of recurrence and no other complications. Robotic repair of traumatic diaphragmatic hernia effectively achieved reduction of herniated contents, primary defect closure, and broad mesh overlap with good results at 1 year. This approach may provide an innovative minimally invasive option for surgeons and patients. Keywords Traumatic diaphragmatic hernia . Robotic . Delayed presentation
Introduction The true prevalence of traumatic diaphragmatic injury (TDI) is difficult to estimate given the often-delayed diagnosis. The reported incidence of diaphragmatic injury after blunt thoracoabdominal trauma is as high as 14% [1, 2]. Leftsided injuries are more common than right [1, 3]. Because the presentation of traumatic diaphragmatic injury continues to be clinically challenging to identify given their occult features, they often present months or even years after a traumatic injury [4]. Missed TDIs can result in devastating consequences, such as incarceration and strangulation of herniated viscus. A retrospective review of 45 patients with diaphragmatic hernias from TDI reported 25% mortality for those who re-presented with symptoms after their initial trauma admission [5].
This article is part of the Topical Collection on Surgery * Katherine Ott [email protected] 1
Department of Surgery, Northwestern University Feinberg School of Medicine, 676 St. Clair St., Suite 2320, Chicago, IL 60611, USA
The standard of care is to repair all traumatic injuries. Thoracoabdominal injuries span five visceral compartments, and therefore, many different approaches to their repair have been described. Additionally, they can be repaired through a thoracic, abdominal, or combined approach. Both thoracoscopic and laparoscopic approaches have been advocated for in both the diagnosis and repair of diaphragmatic ruptures during the acute phase after trauma in select patients. Despite
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