Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog

Laparoscopic Treatment of Peritoneal-Pericardial Diaphragmatic Hernia

Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopic peritoneal-pericardial diaphragmatic hernia repair.

True Diaphragmatic Hernia (Morgagni Hernia) Incidentally Diagnosed with Positive Contrast Peritoneography in a Cat: A Rare Case Report and a Review

An 18-month-old neutered male domestic shorthair cat was presented for an emergency consultation after falling from the second floor. The cat sustained minor traumatic injuries but did not exhibit dyspnea. Routine radiographic examination raised suspicion of a diaphragmatic hernia, but the circumscribed nature of the soft tissues visible in the thorax was atypical for a classic traumatic diaphragmatic hernia. A positive contrast peritoneography highlighted the likely presence of a hernial sac, which strongly suggested a "true diaphragmatic hernia", also known as "pleuroperitoneal hernia". This diagnosis was confirmed during laparotomy, which allowed for the visualization of a 3 cm radial diaphragmatic defect in the right ventral quadrant of the pars sternalis. The diaphragm's edges were rounded. A portion of the falciform ligament and a part of the omentum were protruding through the defect and were contained within a hernial sac. Herniorrhaphy was performed. The cat recovered without complications. Given its presentation and location, ventrally and to the right, this anomaly is analogous to what is described in humans as "Morgagni hernia". Six other cases of Morgagni hernias have probably been reported in cats but were not identified as such. This case underscores the utility of peritoneography, a straightforward technique useful for diagnosing diaphragmatic hernias, which enables differentiation between acquired traumatic forms and congenital forms, particularly peritoneopericardial hernias and pleuroperitoneal hernias. True diaphragmatic hernias are almost always serendipitous discoveries.

Use of a new device for gasless endosurgery in a laparoscopic diaphragmatic hernia repair ex vivo canine model: A pre-clinical study

OBJECTIVES

To test the feasibility of a new device for gasless laparoscopy in providing working space for diaphragmatic hernia repair in an ex vivo canine model as a pre-clinical study.

STUDY DESIGN

Technical feasibility study.

ANIMAL

Eight beagles and two greyhound cadavers (not client-owned).

METHODS

The new device was used for abdominal traction in gasless laparoscopic reconstruction of diaphragmatic hernias produced in dog cadavers. It consists of three main parts (vertical and horizontal rods, a three-piece structure, and a 3D-printed unit that incorporates slots for haemostatic forceps). Composite hernias (two incisions of about 4 cm) were closed by an intra-corporeal suture [suture group (GS), n = 5] or by a central suture and a polypropylene mesh [mesh group (GM), n = 5]. Surgical steps were T1 (primary port access up to third port placement), T2 (defect development), and T3 (diaphragmatic reconstruction). Total surgical time (TT) was also recorded.

RESULTS

The defect was successfully developed and reconstructed in all cadavers. To close the defect, 7.0 ± 0.7 crossed mattress sutures were required in the GS, and 15.2 ± 1.9 hernia staples and one intra-corporal suture were used in the GM. T3 was longer (p = 0.0076) in GS (50.00 ± 16.46 min) than in GM (23.24 ± 5.25 min). TT was 87.22 ± 19.23 min in GS and 66.45 ± 6.38 min in GM (p = 0.0547).

CONCLUSIONS

Gasless laparoscopic diaphragmatic hernia repair using the developed device is feasible in the canine cadaver model. Both suture and mesh graft techniques for experimental diaphragmatic herniorrhaphy can be performed using this new device in this pre-clinical model.

CLINICAL SIGNIFICANCE

This new device for gasless laparoscopy allows diaphragmatic herniorrhaphy by intra-corporeal suture or mesh implantation in ex vivo canine model. The device demonstrates potential for future use in clinical cases.