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Laparoscopic extra-abdominal suturing technique for the repair of Larrey ’ s diaphragmatic hernia using the port closure needle (Endo Close ® ): A case report

View Article: PubMed Central - PubMed

ABSTRACT

Larrey’s diaphragmatic hernia is relatively uncommon.

It is difficult to suture the hernial orifice laparoscopically.

Extra-abdominal suturing technique using Endo Close® may be useful in terms of secure suture and easy tying.

Extra-abdominal suturing technique using Endo Close® may be useful in terms of secure suture and easy tying.

No MeSH data available.


Related in: MedlinePlus

(A) The defect closed by the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using Endo Close®. (B) Placement of all 5 sutures.
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fig0015: (A) The defect closed by the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using Endo Close®. (B) Placement of all 5 sutures.

Mentions: We diagnosed Larrey’s hernia based on the intraoperative findings of an anterior diaphragmatic defect of approximately 4.0 × 4.0 cm located in the left side of the falciform ligament. The transverse colon was found herniating through the defect (Fig. 2A) and was reduced into the peritoneal cavity (Fig. 2B). The mesocolon was adhering to the posterior rim of the defect, and was separated by laparoscopic coagulating shears. The stomach was not herniating through the defect intraoperatively, as it probably returned to the abdominal cavity due to preoperative gastric decompression. Since the hernia was located between the substernal space and the posterior border of the diaphragm, there was no tissue to stitch at the anterior rim of the hernial orifice. Primary closure of the hernial orifice was not possible; hence, we decided to suture the posterior rim of the hernia to the full thickness of the anterior abdominal wall using the extra-abdominal suturing technique. First, a 2-0 Prolene suture attached to a curved needle was inserted into the abdominal cavity. A horizontal mattress suture was taken at the posterior rim of the hernia and the needle was removed from the abdominal cavity. A 2-cm incision was made at the epigastrium above the anterior border of the hernia. The port closure needle (Endo Close®) was inserted into the abdominal cavity, taking one end of the Prolene suture to the outside of the abdominal cavity (Fig. 3A). The other end was similarly removed. Following the same steps, 4 more sutures were placed and held (Fig. 3B). All 5 sutures were tied without tension. The knots were laid in the subcutaneous tissue. Closure of the hernial orifice was observed (Fig. 4). No hernia sac was removed, and using a mesh was not necessary. The operative time was 89 min. The postoperative course was uneventful. The patient underwent rehabilitation postoperatively because of her old age, and was discharged on the 8th postoperative day. There was no evidence of recurrence at 8 months postoperatively.


Laparoscopic extra-abdominal suturing technique for the repair of Larrey ’ s diaphragmatic hernia using the port closure needle (Endo Close ® ): A case report
(A) The defect closed by the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using Endo Close®. (B) Placement of all 5 sutures.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037122&req=5

fig0015: (A) The defect closed by the extra-abdominal suturing technique, suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall using Endo Close®. (B) Placement of all 5 sutures.
Mentions: We diagnosed Larrey’s hernia based on the intraoperative findings of an anterior diaphragmatic defect of approximately 4.0 × 4.0 cm located in the left side of the falciform ligament. The transverse colon was found herniating through the defect (Fig. 2A) and was reduced into the peritoneal cavity (Fig. 2B). The mesocolon was adhering to the posterior rim of the defect, and was separated by laparoscopic coagulating shears. The stomach was not herniating through the defect intraoperatively, as it probably returned to the abdominal cavity due to preoperative gastric decompression. Since the hernia was located between the substernal space and the posterior border of the diaphragm, there was no tissue to stitch at the anterior rim of the hernial orifice. Primary closure of the hernial orifice was not possible; hence, we decided to suture the posterior rim of the hernia to the full thickness of the anterior abdominal wall using the extra-abdominal suturing technique. First, a 2-0 Prolene suture attached to a curved needle was inserted into the abdominal cavity. A horizontal mattress suture was taken at the posterior rim of the hernia and the needle was removed from the abdominal cavity. A 2-cm incision was made at the epigastrium above the anterior border of the hernia. The port closure needle (Endo Close®) was inserted into the abdominal cavity, taking one end of the Prolene suture to the outside of the abdominal cavity (Fig. 3A). The other end was similarly removed. Following the same steps, 4 more sutures were placed and held (Fig. 3B). All 5 sutures were tied without tension. The knots were laid in the subcutaneous tissue. Closure of the hernial orifice was observed (Fig. 4). No hernia sac was removed, and using a mesh was not necessary. The operative time was 89 min. The postoperative course was uneventful. The patient underwent rehabilitation postoperatively because of her old age, and was discharged on the 8th postoperative day. There was no evidence of recurrence at 8 months postoperatively.

View Article: PubMed Central - PubMed

ABSTRACT

Larrey’s diaphragmatic hernia is relatively uncommon.

It is difficult to suture the hernial orifice laparoscopically.

Extra-abdominal suturing technique using Endo Close® may be useful in terms of secure suture and easy tying.

Extra-abdominal suturing technique using Endo Close® may be useful in terms of secure suture and easy tying.

No MeSH data available.


Related in: MedlinePlus