Thoracoscopic Repair of a Bochdalek Hernia in the Prone Position—Report of an Adult Case—

Abstract

Surgical treatment is the choice of therapy for Bochdalek hernia and so far surgical repairs under laparotomy or thoracotomy, or thoracoscopic or laparoscopic repairs have been reported. Recently we have experienced a case of a Bochdalek hernia performed thoracoscopic repair in the prone position with artificial pneumothorax.
The case involved a 49-year-old woman who presented to our hospital because of an abnormal finding detected at a medical checkup. Chest CT scan revealed a hernia at the left dorsal aspect of the diaphragm, and it was diagnosed as Bochdalek hernia. By using artificial pneumothorax intraoperatively, we did not need differential lung ventilation and easily reduced the herniated organs because the pressure difference was created between the thorax and the abdominal cavity. Furthermore the prone position employed in the case produced deviation of the blood, thoracic fluid and pulmonary parenchyma to the ventral side that ensured a good visual field and surgical field. The patient's postoperative course was uneventful, and she was discharged from our hospital on the 4^th postoperative day. Thoracoscopic repair in the prone position with the concomitant use of artificial pneumothorax is a less invasive and beneficial surgical procedure for Bochdalek hernia.