Laparoscopic cholecystectomy in adult with asymptomatic partial agenesis of the right diaphragm: Case report and the literature.

INTRODUCTION: The importance of unilateral diaphragmatic agenesis (DA) in adults for performing a laparoscopic cholecystectomy has not been well described in literature. PRESENTATION OF CASE: A 60-year-old female patient entered our ward in March 2019 for laparoscopic cholecystectomy after 6 months history of epigastric pain and multiple episodes of biliary colic treated conservatively. She never complained of pulmonary symptoms. Preoperative chest Computed tomography (CT) was negative for diaphragmatic or pulmonary pathologies. Laparoscopic cholecystectomy was performed in 60 min with intraoperative detection of a thoracoabdominal communication with partial right hemidiaphragm agenesis. A chest CT and x-ray were performed in the postoperative period with progressive reduction of an asymptomatic small pneumothorax. The patient was discharged at home without complications on the fifth postoperative day. Thoracopulmonary surgery examination was performed without indications for diaphragmatic repair. DISCUSSION: DA is a rare condition and usually occurs in early neonatal period. The congenital form occurs in 1 out of 2200-12500 live births and is traditionally divided into anterior (Morgagni's: 10%) and posterolateral (Bochdalek's: 90%) hernias. Chest and abdomen CT with coronal and sagittal reconstructions is the most effective and useful imaging technique for the diagnosis of diaphragmatic hernia. In literature there are former two case reports of asymptomatic DA in cholelithiasis in which laparoscopic cholecystectomy was performed effectively. CONCLUSION: In adults with partial DA, laparoscopic cholecystectomy can be performed successfully. A conservative management only with gallstones dissolution therapy can be used if laparoscopy cannot be done. Further studies with a higher level of evidence are needed.

Laparoscopic Repair of Ventral and other hernias of the abdominal wall with Composite meshes (Ventralight ST with Echo PS System and Physiomesh): Our case series of 101 patients and the literature.

INTRODUCTION: A meta-analysis of studies has shown that the incidence of ventral hernias varies from 4 to 10%. During the last twenty years, the use of laparoscopic repair of ventral and other hernias of the abdominal wall has rapidly increased. PRESENTATION OF CASES: From January 2011 to March 2020 101 patients underwent laparoscopic ventral hernia repair (LVHR). The diameter of the hernial defect intraoperatively was in average 6.22 ± 5.17 cm (SD) (range 2-30 cm). The difference with the defect diameter measured in CT is small (average 0.77 ± 2.21 cm). The mean operative time was 96.20 min. We used Physiomesh and Secure strap in 37 cases and Ventralight ST plus Sorbafix in 58 cases. The conversion rate was 6.93%. The mean hospital stay was 6.03 days. The 30-day mortality was 0%. The overall morbidity was 11.88%. DISCUSSION: LVHR indications are debated. The IEHS guidelines and the EAES/EHS Consensus conference of 2015 discussed the main indications, contraindications, and features of laparoscopic techniques. Laparoscopic approach seemed to have some benefits: absence of intraparietal dissection, of postoperative immobilization, lower risk of bronchopulmonary complications and lesser abdominal pain. We compared our case series with other similar studies, and we revealed our short-term outcomes are in line with literature. CONCLUSION: Our case series revealed that the LVHR with Ventralight ST/Sorbafix is a safe and effective technique with low postoperative morbidity and low reoperation rate. Careful patient selection is one of the main methods of choice. Studies with higher level of evidence are needed.