Robotic repair of a giant Larrey-type congenital left-sided diaphragmatic hernia in a young woman. A case report and literature review

• Published in: International journal of surgery case reports 2022-09, Vol.98, p.107507, Article 107507
• Main Authors: Nistri, C., Marinelli, L., Di Giacomo, A., Bonariol, L., Massani, M.
• Format: Article
• Language: English
• Subjects: Case Report; Congenital; Diaphragmatic hernia; Minimally invasive surgery; Robotic repair
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107507

Congenital diaphragmatic hernia is a rare condition caused by a malformation in the diaphragm that is usually diagnosed in newborns, infants and children. Sometimes it can be incidentally identified in adults. Once the diagnosis is made, surgery is indicated to avoid the risk of life-threatening complications of herniated viscera. Traditional approaches include laparotomy or thoracotomy or both; in the last decades minimally invasive techniques have proved to be a safe alternative to the open approach but only few cases of robotic hernia repair have been described so far, the most with a combined thoracic-abdomen approach. We report a case of an 18-year-old female presenting with abdominal pain due to a giant left-sided anterior diaphragmatic hernia (Larrey-type) that was repaired using a robotic-assisted laparoscopic approach with mesh placement. The hernia contents included gastric body and fundus, duodenum, jejunum, ileus, cecum, right colon and mesentery; spleen and pancreas were rotated and dislocated anteriorly. The outcome was unremarkable, with no major post-operative complications and no signs of long-term recurrence. The robotic approach seems to be a valid option for the treatment of diaphragmatic hernias, improving post-operative outcome and providing surgeon better visualization, greater precision and enhanced dexterity in a confined space. •Congenital diaphragmatic hernias are a rare condition that may have a late onset.•Once the diagnosis is made, surgery is mandatory due to the risk of life-threatening complications.•Minimally invasive approaches are a safe option for congenital diaphragmatic hernia repair and can improve post-operative outcome.•Robotic diaphragmatic hernia repair allows better visualization, greater precision and enhanced dexterity in a confined space.•The use of a mesh is controversial, but in large defects it is recommended to reinforce the primary repair.