Laparoscopic management of paraduodenal hernias: mesh and mesh-less repairs. A report of four cases |
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Authors: | C Palanivelu M Rangarajan P A Jategaonkar N V Anand K Senthilkumar |
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Institution: | (1) GEM Hospital and Postgraduate Institute, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, Tamil Nadu, India |
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Abstract: | Background Paraduodenal hernias are the most common form of internal hernias. There are few reports in the literature, with the total
number of reported cases being less than 500. We report four patients with paraduodenal hernias causing intestinal obstruction.
Materials and methods All of the four patients with paraduodenal hernias presented with features of intestinal obstruction. A clinical diagnosis
was not made in any of the cases, and computed tomography (CT) scanning was performed to confirm this. They were all successfully
managed by a laparoscopic repair.
Results The operating time was 55–72 mins. Postoperatively, three patients recovered uneventfully, while one patient had ileus for
3 days and, thereafter, recovered spontaneously. Hospital stay was in the range 2–6 days. There were no conversions. One patient
had recurrent paraduodenal hernia, for which a laparoscopic mesh repair was successfully performed.
Discussion The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development.
Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for
all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents.
A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the
literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias.
It carries all of the benefits of minimal access surgery, while providing a sound repair. |
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Keywords: | Paraduodenal hernia Laparoscopic repair Bowel obstruction |
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