PDF(Pubmed)
Abstract：
BACKGROUND: Larrey hernias (LH) are birth defects causing abdominal viscera to protrude into the thoracic cavity. With an incidence of 2-4 %, they are exceptional in adults.
METHODS: A 65-year-old female patient was admitted for an elective laparoscopic cholecystectomy. During history intake, besides biliary colic, no additional symptoms were reported. Physical examination yielded normal results. Chest-X ray did not reveal any anomalies. Intraoperatively, an inspection of the diaphragm revealed a 3 cm defect in the left-sided sternocostal triangle, with the omentum protruding through the thorax. After performing cholecystectomy, the content of the LH was cautiously reduced. The hernia sac was not resected, to prevent potential injury to the neighboring anatomical structures. The defect was closed using non-resorbable interrupted sutures. The postoperative course was uneventful. No recurrence was detected during follow-up.
UNASSIGNED: LH diagnosis is challenging due to its unspecific symptoms. Only 10 % of patients are asymptomatic. CT imaging establishes a positive diagnosis and identifies acute complications requiring emergency management.
CONCLUSIONS: Asymptomatic LH cases mandate surgery. Laparoscopic management is safe and efficient. The trans-abdominal approach offers easier access to hernia content. Hernia sac resection is still debatable. The selection of defect closure technique hinges on the quality and elasticity of the tissue, as well as the size of the defect, all under the unwavering banner of the tension-free principle. Literature remains conflicting on mesh use.
METHODS: A 65-year-old female patient was admitted for an elective laparoscopic cholecystectomy. During history intake, besides biliary colic, no additional symptoms were reported. Physical examination yielded normal results. Chest-X ray did not reveal any anomalies. Intraoperatively, an inspection of the diaphragm revealed a 3 cm defect in the left-sided sternocostal triangle, with the omentum protruding through the thorax. After performing cholecystectomy, the content of the LH was cautiously reduced. The hernia sac was not resected, to prevent potential injury to the neighboring anatomical structures. The defect was closed using non-resorbable interrupted sutures. The postoperative course was uneventful. No recurrence was detected during follow-up.
UNASSIGNED: LH diagnosis is challenging due to its unspecific symptoms. Only 10 % of patients are asymptomatic. CT imaging establishes a positive diagnosis and identifies acute complications requiring emergency management.
CONCLUSIONS: Asymptomatic LH cases mandate surgery. Laparoscopic management is safe and efficient. The trans-abdominal approach offers easier access to hernia content. Hernia sac resection is still debatable. The selection of defect closure technique hinges on the quality and elasticity of the tissue, as well as the size of the defect, all under the unwavering banner of the tension-free principle. Literature remains conflicting on mesh use.
摘要：
背景：拉瑞氏疝（LH）是导致腹部内脏突出到胸腔的出生缺陷。发病率为2-4%，他们是特殊的成年人。
方法：一名65岁女性患者接受择期腹腔镜胆囊切除术。在病史摄入期间，除了胆绞痛,未报告其他症状.体格检查结果正常。胸部X光没有发现任何异常。术中,检查隔膜发现左侧胸肋三角形有3厘米的缺损，网膜从胸腔突出.行胆囊切除术后,LH的含量谨慎降低。疝囊没有切除,以防止对邻近解剖结构的潜在伤害。使用不可吸收的间断缝线闭合缺损。术后病程顺利。随访期间未发现复发。
■LH诊断由于其非特异性症状而具有挑战性。只有10%的患者无症状。CT成像建立了积极的诊断，并确定了需要紧急处理的急性并发症。
结论：无症状LH病例需要手术治疗。腹腔镜治疗是安全有效的。经腹方法更容易获得疝气内容物。疝囊切除仍有争议。缺损闭合技术的选择取决于组织的质量和弹性，以及缺陷的大小，所有这些都在无紧张原则的坚定不移的旗帜下。文献在网格使用方面仍然存在冲突。
方法：一名65岁女性患者接受择期腹腔镜胆囊切除术。在病史摄入期间，除了胆绞痛,未报告其他症状.体格检查结果正常。胸部X光没有发现任何异常。术中,检查隔膜发现左侧胸肋三角形有3厘米的缺损，网膜从胸腔突出.行胆囊切除术后,LH的含量谨慎降低。疝囊没有切除,以防止对邻近解剖结构的潜在伤害。使用不可吸收的间断缝线闭合缺损。术后病程顺利。随访期间未发现复发。
■LH诊断由于其非特异性症状而具有挑战性。只有10%的患者无症状。CT成像建立了积极的诊断，并确定了需要紧急处理的急性并发症。
结论：无症状LH病例需要手术治疗。腹腔镜治疗是安全有效的。经腹方法更容易获得疝气内容物。疝囊切除仍有争议。缺损闭合技术的选择取决于组织的质量和弹性，以及缺陷的大小，所有这些都在无紧张原则的坚定不移的旗帜下。文献在网格使用方面仍然存在冲突。
