الفهرس 
Anatomy & EmbryologyOnly 14 pages are availabe for public view
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Abstract
Diaphragmatic hernia has been classified into the following different types: Eventeration of diaphragm, posterolateral hernia of Bochdalek (aka, BH), parasternal hernia of Morgagni-Larrey, pertioneopericardial hernia, and the central tendon hernias.
The clinical symptoms of CDH are frequently vague and nonspecific and include chest and/or abdominal symptoms. Moreover, they could be intermittent, as herniated viscera can spontaneously reduce, causing symptom regression.
The herniated bowel loops may be complicated, such as in obstruction or volvulus, and the fluid-filled bowel loops appear as an opacity mimicking a lung consolidation. In other cases the gas-filled bowel loops may simulate a pneumothorax.
The hernia can be repaired by a variety of surgical approaches including laparotomy, thoracotomy, thoracoscopy, laparoscopy but the laparoscopic approach has been the gold standard and the initial step for repair of non-complicated cases.
Minimal invasive approach(laparoscopy) in the repair of CDH was became a standard of care during the last two decades, as laparoscopy offers faster recovery, shorter hospital stay and less morbidity than traditional laparotomy.
The approach to repair depends on the presentation (emergency or elective), size and side of the defect, and the presence of complications.
The repair of the hernial defect can be made with non-absorbable or absorbable suturing material; however, the use of non-absorbable suturing is widely recommended. Both interrupted and continuous techniques are equally effective while simple suture is sufficient in smaller defects, larger defects need a synthetic mesh.
Many types of mesh are available for use in these types of repair. Polypropylene mesh has the benefit of providing indefinite support and excellent tissue growth.
Following surgery, while some would place an intercostal drainage tube to drain the chest, others would manage with transabdominal suction catheter to evacuate the thorax, just before deflation of the abdomen following the repair.
Potential complications include injury to gut including perforation and bleeding while reducing and handling an edematous content. Moreover disruption of the spleen with bleeding or injury to the tail of pancreas during manipulation could also result.
Pneumothorax has been recognized as a potential complication during laparoscopic diaphragm defect repair. Patients with persistent pneumothorax would need intercostal tube insertion in the postoperative period.
Diaphragmatic hernia has been classified into the following different types: Eventeration of diaphragm, posterolateral hernia of Bochdalek (aka, BH), parasternal hernia of Morgagni-Larrey, pertioneopericardial hernia, and the central tendon hernias.
The clinical symptoms of CDH are frequently vague and nonspecific and include chest and/or abdominal symptoms. Moreover, they could be intermittent, as herniated viscera can spontaneously reduce, causing symptom regression.
The herniated bowel loops may be complicated, such as in obstruction or volvulus, and the fluid-filled bowel loops appear as an opacity mimicking a lung consolidation. In other cases the gas-filled bowel loops may simulate a pneumothorax.
The hernia can be repaired by a variety of surgical approaches including laparotomy, thoracotomy, thoracoscopy, laparoscopy but the laparoscopic approach has been the gold standard and the initial step for repair of non-complicated cases.
Minimal invasive approach(laparoscopy) in the repair of CDH was became a standard of care during the last two decades, as laparoscopy offers faster recovery, shorter hospital stay and less morbidity than traditional laparotomy.
The approach to repair depends on the presentation (emergency or elective), size and side of the defect, and the presence of complications.
The repair of the hernial defect can be made with non-absorbable or absorbable suturing material; however, the use of non-absorbable suturing is widely recommended. Both interrupted and continuous techniques are equally effective while simple suture is sufficient in smaller defects, larger defects need a synthetic mesh.
Many types of mesh are available for use in these types of repair. Polypropylene mesh has the benefit of providing indefinite support and excellent tissue growth.
Following surgery, while some would place an intercostal drainage tube to drain the chest, others would manage with transabdominal suction catheter to evacuate the thorax, just before deflation of the abdomen following the repair.
Potential complications include injury to gut including perforation and bleeding while reducing and handling an edematous content. Moreover disruption of the spleen with bleeding or injury to the tail of pancreas during manipulation could also result.
Pneumothorax has been recognized as a potential complication during laparoscopic diaphragm defect repair. Patients with persistent pneumothorax would need intercostal tube insertion in the postoperative period.