Thoracoscopic Herniorrhaphy for Late-presenting Congenital Diaphragmatic Hernia Using Surgical Stapling Device: A Case Report

Abstract

In a 6-month-old boy who presented with cough and fever, an elevation of the right diaphragm was recognized following a chest X-ray. Chest computed tomography demonstrated a herniation of the right liver lobe into the thoracic cavity. Therefore, he was diagnosed as having congenital diaphragmatic hernia (CDH), and thoracoscopic repair of the hernia was performed. A huge hernia sac obstructed the field of view. The hernia sac slid on the right liver lobe, so we judged that there was no adhesion. Thus, the hernia sac was resected using a surgical stapling device, which improved the visibility of the thoracic cavity, and the normal diaphragmatic rim was clearly recognized. The muscle part of the diaphragm was easily sutured linearly. He was discharged on postoperative day 6 without any surgical complications. There were no recurrent signs as of 36 months postoperatively. The resection of a huge hernia sac that interrupts the field of view may be useful for surgery with the restriction of a small working space. We need clear patient criteria and more observations for long-term complications.