Strategies for diagnosis and treatment of adult diaphragmatic hernia
10.3760/cma.j.cn113855-20250723-00369
- VernacularTitle:成人膈疝的诊治策略
- Author:
Shangeng WENG
1
;
Yiping CHEN
1
;
Xiang ZHANG
1
Author Information
1. 福建医科大学附属第一医院肝胆胰、疝外科 福建省腹部外科研究所，福州 350005
- Publication Type:Journal Article
- Keywords:
Herniorrhaphy;
Hernia,diaphragmatic;
Adult;
Diagnosis;
Treatment
- From:
Chinese Journal of General Surgery
2025;40(9):677-682
- CountryChina
- Language:Chinese
-
Abstract:
The incidence rate of adult diaphragmatic hernia is low, which can be divided into congenital diaphragmatic hernia and acquired diaphragmatic hernia. In emergency situations, it may present as incarceration or strangulation. In non-emergency situations, it may be asymptomatic or present with nonspecific respiratory and digestive symptoms, making it prone to misdiagnosis and missed diagnosis. For suspected cases, multi-slice spiral CT examination should be performed, with attention paid to sagittal imaging. In emergency situations, CT contrast-enhanced scanning should be focusing on assessing the viability of the hernia contents. Once diagnosed, surgical treatment should be performed, with transabdominal approach being the preferred choice. In emergency situations, laparoscopic exploration and repair can be considered for patients with stable hemodynamics. For delayed traumatic diaphragmatic hernia and adult congenital diaphragmatic hernia with large defects, the necessity of a thoracic approach should be considered. During surgery, the complete removal of the hernia sac should not be pursued. The decision to remove or partially remove the hernia sac should be evaluated based on intraoperative conditions. Intraoperative diaphragmatic defects should be closed as much as possible with non-absorbable sutures. For diaphragmatic defects that are tensioned after suturing, or those close to the costal margin, anti-adhesion mesh should be used by intraperitoneal repair approach. When fixing the patch near the pericardium, the use of tacks should be avoided.
