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Yongue C, Geraci TC, Chang SH. Management of Diaphragm Paralysis and Eventration. Thorac Surg Clin 2024; 34:179-187. [PMID: 38705666 DOI: 10.1016/j.thorsurg.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
An elevated diaphragm may be due to eventration or paralysis. Diaphragm elevation is often asymptomatic and found incidentally on imaging. Fluoroscopic testing can be used to differentiate eventration (no paradoxic motion) from paralysis (paradoxic motion). Regardless of etiology, a diaphragm plication is indicated in all symptomatic patients with an elevated diaphragm. Plication can be approached either from a thoracic or abdominal approach, though most thoracic surgeons perform minimally invasive thoracoscopic plication. The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphragm. Diaphragm plication is safe, has excellent outcomes, and is associated with symptom improvement.
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Affiliation(s)
- Camille Yongue
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA.
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2
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Sok F, Cohen R, Mauvais F. Ventral hernia: Treatment using the intraperitoneal "suture-stayed prosthesis" technique. J Visc Surg 2023:S1878-7886(23)00044-9. [PMID: 37419775 DOI: 10.1016/j.jviscsurg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- F Sok
- Digestive surgery department, Beauvais hospital center, 60000 Beauvais, ,France
| | - R Cohen
- Digestive surgery department, Beauvais hospital center, 60000 Beauvais, ,France
| | - F Mauvais
- Digestive surgery department, Beauvais hospital center, 60000 Beauvais, ,France.
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3
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Sharan Kumar V. Eventeration of diaphragm with Chilaiditi sign - A rare occurrence. Respir Med Case Rep 2021; 34:101457. [PMID: 34401313 DOI: 10.1016/j.rmcr.2021.101457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022] Open
Abstract
Chilaiditi sign, a rare radiographic finding of hepatodiaphragmatic interposition of hollow viscera, colon or bowel, was first described by Demetrius Chilaiditi. Diaphragmatic eventration occurs when there is a partial or entire elevation of the diaphragm due to thinned musculature of the diaphragm itself. We present a case report of a 47 year old male patient who presented to emergency department with breathlessness, fever & chest pain. This case carries a clinical significance as it could have let to a wide range of complications like bowel volvulus, obstruction & perforation.
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P P, Karmacharya R, Vaidya S, Singh A, Thapa P, Dhakal P, Dahal S, Bade S, Bhandari N. Case report of eventration of diaphragm due to an unknown febrile illness causing phrenic nerve palsy and other multiple nerve palsies. Ann Med Surg (Lond) 2020; 54:74-78. [PMID: 32382413 PMCID: PMC7201156 DOI: 10.1016/j.amsu.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Diaphragmatic eventration can be congenital or acquired. Diagnosis is delayed due to no symptoms or very mild ones and is generally done by imaging modalities. This condition is managed by plication of the affected part of diaphragm by various surgical approaches. PRESENTATION OF CASE A forty seven years lady presented with one year long history of abdominal pain, bloating and fullness after meals who was being treated in line of peptic acid disorder. She had developed bilateral foot drop after typhoid fever at seventeen years of age. Clinical examination and imaging with chest x-ray, chest ultrasound and computed tomography scan suggested eventration of left hemidiaphragm. Plication of eventration of left hemidiaphragm was done via mini thoracotomy of the left thorax. There were no postoperative complications and she was discharged on the sixth postoperative day. DISCUSSION Acquired eventration of diaphragm is commonly due to traumatic phrenic nerve palsy but rarely can be associated with a history of infection causing nerve palsies. Thoracic ultrasound is an emerging modality for diagnosis supporting X-rays and CT Scans. Plication of eventration with minimally invasive techniques has less number of hospital stay and less pain compared to open approaches. CONCLUSION Non-traumatic diaphragmatic eventration due to acquired phrenic nerve palsy following an unknown febrile illness is a rare case to be reported in Nepal. The aim of treatment is expansion of intra-thoracic space which is done by plication of the diaphragm.
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Affiliation(s)
- Pradhan P
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - R.M. Karmacharya
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Vaidya
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - A.K. Singh
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - P Thapa
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - P Dhakal
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Dahal
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - S Bade
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
| | - N Bhandari
- Department of Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Nepal
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Salido Fernandez S, Fraile Vilarrasa M, Osorio Silla I, Georgiev Hristov T, Bernar de Oriol J, González-Ayora S, Pardo García R, Guadalajara Labajo H. Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results. Cir Esp 2020; 98:260-6. [PMID: 32172955 DOI: 10.1016/j.ciresp.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. METHODS Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. RESULTS Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. CONCLUSIONS Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.
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Heiwegen K, van Heijst AFJ, Daniels-Scharbatke H, van Peperstraten MCP, de Blaauw I, Botden SMBI. Congenital diaphragmatic eventration and hernia sac compared to CDH with true defects: a retrospective cohort study. Eur J Pediatr 2020; 179:855-863. [PMID: 31965300 PMCID: PMC7220865 DOI: 10.1007/s00431-020-03576-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
Congenital diaphragmatic eventration (CDE) and congenital diaphragmatic hernia (CDH) with or without hernia sac are three different types of congenital diaphragmatic malformations, which this study evaluates. All surgically treated patients with CDE or Bochdalek type CDH between 2000 and 2016 were included in this retrospective analysis. Demographics, CDH-characteristics, treatment, and clinical outcome were evaluated. In total, 200 patients were included. Patients with an eventration or hernia sac had no significant differences and were compared as patients without a true defect to patients with a true defect. The 1-year survival of patients with a true defect was significantly lower than patients with no true defect (76% versus 97%, p = 0.001). CDH with no true defect had significantly better short-term outcomes than CDH with true defect requiring patch repair. However, at 30 days, they more often required oxygen supplementation (46% versus 26%, p = 0.03) and had a higher recurrence rate (8% versus 0%, p = 0.006) (three eventration and two hernia sac patients). Conclusion: Patients without a true defect seem to have a more similar clinical outcome than CDH patients with a true defect, with a better survival. However, the recurrence rate and duration of oxygen supplementation at 30 days are higher than CDH patients with a true defect.What is Known:• Congenital diaphragmatic hernia with or without hernia sac and congenital diaphragmatic eventration (incomplete muscularization) are often treated similarly.• Patients with hernia sac and eventration are thought to have a relatively good outcome, but exact numbers are not described.What is New:• Congenital diaphragmatic eventration and patients with hernia sac seem to have a more similar clinical outcome than Bochdalek type CDH with a true defect.• Patients without a true defect (eventration or hernia sac) have a high recurrence rate.
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Affiliation(s)
- Kim Heiwegen
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Arno FJ van Heijst
- Department of Neonatology, Radboudumc-Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Horst Daniels-Scharbatke
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Michelle CP van Peperstraten
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Ivo de Blaauw
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Sanne MBI Botden
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
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Rishniw M, Kogan LR. Post-surgical evisceration with or without autocannibalism in 333 dogs-a survey of veterinarians. Open Vet J 2019; 9:327-330. [PMID: 32042654 PMCID: PMC6971363 DOI: 10.4314/ovj.v9i4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Few reports of post-surgical evisceration, with or without autocannibalism, in dogs exist. Aims To collect a large case series of dogs experiencing post-surgical evisceration, with or without autocannibalism. Methods We surveyed practicing veterinarians who were members of the Veterinary Information Network about their experiences with post-surgical evisceration in dogs, variably accompanied by autocannibalism (ingestion of eviscerated organs or tissues). Responses were analyzed using descriptive statistics. Results We identified 333 cases with sufficient information for analysis: 221 with evisceration and autocannibalism, and 112 with just evisceration. Most cases occurred following surgery for reproductive reasons (desexing, cesarean section, and pyometra). Most occurred in young adult or adult dogs. Most dogs received analgesia perioperatively had routine closure (simple interrupted or simple continuous muscle layer closure) and most did not wear an E-collar post-surgically. Most dogs eviscerated within 3 days of the initial surgery. Approximately 64% underwent surgical repair and survived long-term without complications, more frequently if the evisceration was not accompanied by autocannibalism. Conclusion Our study suggests that post-surgical evisceration and autocannibalism can generally be successfully managed by practitioners and do not confer a uniformly poor outcome for the dog.
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Affiliation(s)
| | - Lori R Kogan
- Clinical Sciences Department, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Karmazyn B, Shold AJ, Delaney LR, Brown BP, Marine MB, Jennings SG, Gray BW. Ultrasound evaluation of right diaphragmatic eventration and hernia. Pediatr Radiol 2019; 49:1010-1017. [PMID: 31139880 DOI: 10.1007/s00247-019-04417-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/11/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND A hernia is due to a defect in the diaphragm. An eventration is due to a thinned diaphragm with no central muscle. Distinguishing right diaphragmatic hernia from eventration on chest radiographs can be challenging if no bowel loops are herniated above the diaphragm. Experience is limited with postnatal ultrasound (US) evaluation of diaphragmatic hernia or eventration. OBJECTIVE To evaluate for specific US signs in the diagnosis of right diaphragmatic hernia and eventration. MATERIALS AND METHODS We identified all patients (January 2007-December 2017) with right diaphragm US and surgery for eventration or hernia. We reviewed medical charts, and US images/reports for clinical presentation and diaphragm abnormalities. Surgical diagnosis was considered the reference standard. RESULTS Seventeen children (mean age: 5 months) had US examination before surgery for hernia (n=9) or eventration (n=8). The most common presentation was respiratory distress. In the US reports, hernia was correctly diagnosed in all patients and three patients with eventration were misdiagnosed as hernia, yielding 100% sensitivity and 62.5% specificity. In a retrospective evaluation of the US studies, a combination of folding of a free muscle edge with a narrow angle waist had 100% specificity for hernia and was seen in 7/9 children with hernia. Combination of a broad angle waist and hypoechoic strip of diaphragmatic muscle covering the waist had 100% specificity for eventration and was demonstrated in 4/8 children with eventration. Five of 17 patients (31.6%) had no specific sign that differentiated hernia from eventration. CONCLUSION On US, folding of the free edge of the diaphragm and a narrow angle waist are specific for hernia; a broad angle waist with muscle covering the elevated area is specific for eventration. Definitive differentiation between eventration and hernia may not be possible in about a third of patients.
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Affiliation(s)
- Boaz Karmazyn
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University, 705 Riley Hospital Dr., Rm. 1053, Indianapolis, IN, 46202, USA.
| | - Andrew J Shold
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa R Delaney
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University, 705 Riley Hospital Dr., Rm. 1053, Indianapolis, IN, 46202, USA
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University, 705 Riley Hospital Dr., Rm. 1053, Indianapolis, IN, 46202, USA
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University, 705 Riley Hospital Dr., Rm. 1053, Indianapolis, IN, 46202, USA
| | - S Gregory Jennings
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - Brian W Gray
- Department of Pediatric Surgery, Riley Hospital for Children, Indiana University, Indianapolis, IN, USA
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Hernández-Granados P, López-Cano M, Morales-Conde S, Muysoms F, García-Alamino J, Pereira-Rodríguez JA. Incisional hernia prevention and use of mesh. A narrative review. Cir Esp 2018; 96:76-87. [PMID: 29454636 DOI: 10.1016/j.ciresp.2018.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Abstract
Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review.
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Affiliation(s)
- Pilar Hernández-Granados
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Sección de Pared Abdominal de la Asociación Española de Cirujanos, España.
| | - Manuel López-Cano
- Sección de Pared Abdominal de la Asociación Española de Cirujanos, España; Unidad de Pared Abdominal, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Salvador Morales-Conde
- Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Sevilla, España; Secretaría General, European Hernia Society
| | - Filip Muysoms
- Servicio de Cirugía, Hospital Maria Middelares, Ghent, Bélgica
| | - Josep García-Alamino
- Department of Primary Care Health Sciencies, University of Oxford, Oxford, Reino Unido
| | - José Antonio Pereira-Rodríguez
- Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Hospital del Mar. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
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Abstract
Diaphragmatic eventration is an uncommon condition, usually discovered incidentally in asymptomatic patients. Even in symptomatic patients, the diagnosis can be challenging and should be considered among the differential diagnoses of diaphragmatic hernia. The correct diagnosis can often only be made in surgery. We describe the case of a 31-year-old patient with diaphragmatic eventration that was misdiagnosed as a recurrent congenital diaphragmatic hernia and review the corresponding literature.
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Affiliation(s)
- C Shwaartz
- Icahn School of Medicine at Mount Sinai , New York , US
| | - E Duggan
- Icahn School of Medicine at Mount Sinai , New York , US
| | - D S Lee
- Icahn School of Medicine at Mount Sinai , New York , US
| | - C M Divino
- Icahn School of Medicine at Mount Sinai , New York , US
| | - E H Chin
- Icahn School of Medicine at Mount Sinai , New York , US
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Bacha S, Habibech S, Attia M, Cheikhrouhou S, Chaouch N, Racil H, Chabbou A. [Pulmonary opacity]. Rev Med Interne 2017; 39:441-442. [PMID: 28277264 DOI: 10.1016/j.revmed.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
- S Bacha
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie.
| | - S Habibech
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - M Attia
- Service de radiologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - S Cheikhrouhou
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - N Chaouch
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - H Racil
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - A Chabbou
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
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Kim W, Courtier J, Morin C, Shet N, Strauch E, Kim JS. Postnatal MRI for CDH: A pictorial review of late-presenting and recurrent diaphragmatic defects. Clin Imaging 2017; 43:158-164. [PMID: 28324716 DOI: 10.1016/j.clinimag.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/30/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
Late-presenting or recurrent diaphragmatic defects can pose a diagnostic challenge due to varying clinical presentations. Current diagnostic approaches include plain film radiograph for initial assessment, with other imaging modalities such as fluoroscopy, ultrasound, CT and MRI mainly utilized for troubleshooting. As a radiation-free modality, MRI can provide a more definitive diagnosis in particular cases due to its ability to visualize discontinuity of the diaphragm, distinguishing it from eventration. MRI can also accurately characterize hernia contents, defect location and size. We present our MRI technique and review cases of different hernia types with relevant discussion of the imaging findings and correlation with intraoperative findings. MRI can be a useful diagnostic tool in the assessment of late presenting or recurrent diaphragmatic hernias.
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Affiliation(s)
- Wendy Kim
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201, United States; Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
| | - Jesse Courtier
- Department of Radiology, University of California San Francisco Benioff Children's Hospital, 1975 4th St, San Francisco, CA 94158
| | - Cara Morin
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201, United States
| | - Narendra Shet
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201, United States
| | - Eric Strauch
- Department of Surgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201, United States
| | - Jane S Kim
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD 21201, United States
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Özkan S, Yazici Ü, Aydin E, Karaoğlanoğlu N. Is surgical plication necessary in diaphragm eventration? Asian J Surg 2016; 39:59-65. [PMID: 26117205 DOI: 10.1016/j.asjsur.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. METHODS Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control; then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters-forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs-conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey-using a questionnaire that consisted of multiple choice questions with answer options such as "better," "the same," and "worse"-to understand preoperative and postoperative symptom levels in the 12(th) month of postoperative control. RESULTS According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1(st) postoperative month, 6(th) postoperative month, and 12(th) postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. CONCLUSION Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group; surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.
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Abstract
Diaphragmatic eventration and diaphragmatic paralysis are 2 entities with different etiology and pathology, and are often clinically indistinguishable. When symptomatic, their treatment is the same, with the objective to reduce the dysfunctional cephalad excursion of the diaphragm during inspiration. This can be achieved with diaphragmatic plication through the thorax or the abdomen with either open or minimally invasive techniques. We prefer the laparoscopic approach, due to its easy access to the diaphragm and to avoid pain associated with intercostal incisions and instrument use. Short-term and long-term results are excellent with this technique.
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Affiliation(s)
- Eitan Podgaetz
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA.
| | - Rafael Garza-Castillon
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
| | - Rafael S Andrade
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
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Yalcinkaya I, Evman S, Lacin T, Alpay L, Kupeli M, Ocakcioglu I. Video-assisted minimally invasive diaphragmatic plication: feasibility of a recognized procedure through an uncharacteristic hybrid approach. Surg Endosc 2017; 31:1772-7. [PMID: 27519592 DOI: 10.1007/s00464-016-5171-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diaphragmatic plication is an approved surgical procedure for treatment of symptomatic diaphragmatic paralysis and eventration. We aim to define our minimally invasive technique of plication and objectively assess our surgical outcomes of the largest series reported in the literature so far, using pulmonary function tests. METHODS Symptomatic patients whom were planned to undergo plication using video-assisted mini-thoracotomy between December 2009 and December 2015 were the cohort of this retrospective study. Single camera port and a utility incision (3-4 cm) were used for access. Data of patient demographics with preoperative and postoperative spirometric results were collected for statistical comparison. RESULTS Procedure (30 left, 7 right) was completed in 37 (27 male, 10 female) patients. One patient was excluded because of insufficient objective postoperative comparison criteria due to previous permanent tracheostomy. Mean length of surgery was 48.8 ± 19.7 (range: 30-70) min. Postoperative overall morbidity was 8.3 %, with no mortality. The mean length of hospital stay was 3.1 ± 1.7 days. All patients except one (97.3 %) were asymptomatic on discharge and on follow-ups. Significant improvement in measurements of forced expiratory volume in 1st second was observed on postoperative measurements (P < 0.001), with a mean overall increase of 13 % in whole cohort. No recurrence was detected throughout a mean follow-up of 19 months. CONCLUSIONS Diaphragmatic plication via video-assisted mini-thoracotomy is an effective and curative surgical procedure which can be performed successfully with low morbidity rates. As it combines the rapidity and economical benefits of open thoracotomy with the advantages of video thoracoscopic procedures such as fast recovery and short postoperative hospital stay, it can be preferred as a safe and effective alternative hybrid method compared to standard open or closed techniques, for symptomatic patients with non-functional hemidiaphragm.
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Orlandini CF, Steiner D, Boscarato AG, Gimenes GC, Alberton LR. Surgical treatment of traumatic eventration with polyester button and polypropylene mesh to strengthen the suture technique in equine. BMC Vet Res 2016; 12:58. [PMID: 26995736 DOI: 10.1186/s12917-016-0686-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background Defects in the abdominal wall of horses have high relapse rate. This is mainly in lateral eventrations and hernias caused by trauma from kicks of other horses or installation structures. The eventration region normally becomes swollen and there may be complications due to intestinal loop incarceration. The surgical treatment, consisting of reconstruction of the abdominal wall, frequently require biological or synthetic materials for the reinforcement of the suture line and tension support. Therefore, several studies have reported new materials for the repair of the abdominal wall, with the aim of improving the integration among adjacent tissues and reducing risks and complications such as rejection and infection. This report describes for the first time the use of a regular polypropylene mesh reinforced with polyester buttons for the herniorrhaphy. Case presentation A male, three-year-old, Appaloosa with 500 Kg presented to our hospital with a 10 days history of an increased volume on the left ventro-lateral region of the abdomen. During the physical examination, a deventration following traumatic rupture of the abdominal wall was diagnosed via ultrasonography. Then, the equine was anesthetized and moved to surgery for correction of the eventration which was performed according to conventional technique described in literature. Two days later, an eventration relapse was observed and confirmed via ultrasonography. After that, a second surgical intervention was performed using polyester buttons and polypropylene mesh. After the second surgical procedure, no complications related to eventration were observed either intra or postoperatively. After that, a recheck was performed thirty days later where satisfactory wound healing and total recovery were observed. Conclusion The use of polypropylene mesh reinforced with polyester buttons is an effective technique for the repair of traumatic eventration in horses. This technique provides effective reinforcement against the abdominal tension and was a good option for reconstruction of lacerated muscles in cases of equine post-traumatic eventration, including relapsing cases.
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Alshorbagy A, Mubarak Y. Open Transthoracic Plication of the Diaphragm for Unilateral Diaphragmatic Eventration in Infants and Children. Korean J Thorac Cardiovasc Surg 2015; 48:307-10. [PMID: 26509123 PMCID: PMC4622030 DOI: 10.5090/kjtcs.2015.48.5.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
Background To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.
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Affiliation(s)
| | - Yasser Mubarak
- Cardiothoracic Surgery Department, Minia University Hospital
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López Sanclemente MC, Robres J, López Cano M, Barri J, Lozoya R, López S, Vasco MA, Buqueras MC, Subirana H, Jorba R. [Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall]. Cir Esp 2013; 91:444-9. [PMID: 23473433 DOI: 10.1016/j.ciresp.2012.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 07/05/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. MATERIALS AND METHODS We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010. RESULTS Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. CONCLUSIONS Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.
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Affiliation(s)
- María Clara López Sanclemente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General de L'Hospitalet Consorci Sanitari Integral, Hospitalet del Llobregat, Barcelona, España.
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Abstract
We report three infants who presented with acute gastric volvulus and recovered initially after de-torsion, but later presented with sequelae due to ischemia of gastroesophageal junction, stomach and gastroduodenal junction. The first two infants could not be fed orally or by gastrostomy tube because of microgastria and stricture of the lower esophagus and gastroduodenal junction, and were managed on jejunostomy feeds, while the third child was managed on gastrostomy feeds till the gastric substitution surgery. The first case was treated nonsurgically with repeated dilatations, but ultimately succumbed to sepsis and malnutrition. In the second child, attempted dilatation resulted in esophageal perforation and she was reconstructed using ileocecal segment as a substitute for stomach and lower esophagus, and has done well. The third child was managed surgically by the Hunt Lawrence J pouch as stomach substitute and has also done well.
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