VA02.7. Robotic Repair of the Rare Right Sided Bochdalek Hernia in a Young Adult

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ID: 325910
2026
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Ranked #346 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Other Background Bochdalek hernia (BH) is a developmental defect in the posterolateral diaphragm and is the most common form of congenital diaphragmatic hernias (CDH). BH occurs commonly on the left side, while right-sided hernias are uncommon. Estimated prevalence of CDH from population-based studies is 1/4000 births. CDH Typically presents with respiratory symptoms in the pediatric age group, but occasionally seen in adults. CDH is associated with trisomy 21, 18, and 13 Methods We present the case of a 21 y.o. male with history of trisomy 21. He presented with large right diaphragmatic hernia which was discovered incidentally after a low-speed motor vehicle collision. He had a long-standing history of non-specific right sided abdominal pain but no dyspnea, dysphagia or chest pain. His surgical history was significant for a complete atrioventricular septal defect s/p open cardiac surgery as an infant, gastrostomy tube placement and a hypospadias repair. His physical exam was unremarkable. The CT scan demonstrated a large right-sided diaphragmatic hernia containing small bowel, colon and right kidney. The patient was advised a robotic repair of the diaphragmatic hernia. Results After induction of anesthesia he was placed in a left lateral decubitus position and four robotic trocars were placed along the right subcostal margin. Upon entry into the abdomen, a large right-sided diaphragmatic hernia was seen posterior to the liver.We began by dividing the right triangular ligament of the liver. A segment of small bowel was easily reduced out of the hernia defect. The hernia sac was dissected free from the diaphragm circumferentially, and after some time we were able to completely reduce the hernia sac containing the colon and right kidney. The hernia defect measured 10 x 6 cm and was too big to close primarily. A medium weight coated mesh was cut to 14 x 14 cm for adequate coverage and perform an inlay or bridging repair. His post operative course was relatively unremarkable. CT scan performed after a month demonstrated an intact repair. Conclusion Right sided Bochdalek hernia in adults are rare. Robotic repair even for large hernias is safe and feasible. Minimally invasive transperitoneal repair should be the standard of care for all diaphragmatic hernias as it avoids the morbidity associated with open abdominal or thoracic operations Video Description The video highlights a right sided Bochdalek hernia in an adults. Bochdalek hernia are a common form of congenital diaphragmatic hernias but not commonly see in adults. The vast majority of these hernias occur on the left side and right sided hernias are exceedingly uncommon. The rarity of this condition makes this a unique video. The video highlights the unique patient positioning for this case, safe reduction of the viscera in this case the right kidney and performance of a bridging or inlay repair when a primary closure of the hernia defect is not possible.
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Authors Ruchir Puri, Isabela Visintin
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.442
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.442/70760151/doag077.442.pdf
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