Retroperitoneal totally endoscopic prosthetic repair of adult Bochdalek hernia: a multicenter retrospective cohort study.

Abstract

<h4>Purpose</h4>Bochdalek hernia (BH) is a rare congenital diaphragmatic defect in adults, often presenting with nonspecific symptoms and posing challenges in diagnosis and treatment. Traditional open surgery is associated with significant trauma, while minimally invasive techniques have gained popularity. This multicenter retrospective cohort study aimed to evaluate the feasibility and short-term efficacy of the retroperitoneal totally endoscopic prosthetic (R-TEP) repair technique for adult BHs.<h4>Methods</h4>A retrospective review was conducted on ten adult patients with BHs who underwent R-TEP repair from February 2022 to December 2023 across four tertiary hospitals. Patient demographics, hernia characteristics, operative details, perioperative complications, and follow-up outcomes were analyzed. Continuous variables are presented as median (range).<h4>Results</h4>The median age of the patients was 53.50 years (range: 23-66), with a median body mass index (BMI) of 25.01 kg/m² (range: 22.31-27.94). The majority of patients (80%) presented with left-sided hernias. The median defect area was 13.50 cm² (range: 6-42), with a median mesh area of 145.00 cm² (range: 130-170). The median operative time was 117.50 min (range: 90-180), with minimal intraoperative blood loss. One patient with a larger defect (42 cm²) required conversion to laparoscopic intraperitoneal onlay mesh (IPOM) repair due to excessive defect size, limited operative field, and peritoneal injury. All other operations were successfully performed without serious intraoperative complications. The median postoperative hospital stay was 2.50 days (range: 2-4). No major postoperative complications occurred, and no recurrence was observed during a median follow-up period of 29.5 months (range: 20-42). Compared with baseline, Carolina comfort scale (CCS) scores for pain, mesh sensation, and movement limitation all improved significantly at the 6-month follow-up.<h4>Conclusion</h4>The R-TEP repair technique for adult BHs is safe, effective, and reproducible. It offers a minimally invasive approach with favorable outcomes, including reduced postoperative pain, shorter hospital stays, and a low recurrence rate. This technique is a valuable addition to the surgical management of adult BHs and merits validation in larger prospective studies.