Robotic surgery to fix a rare diaphragmatic hernia in a 71-year-old

Abstract

BACKGROUND Parahiatal hernias (PHHs) are uncommon diaphragmatic defects that can resemble paraesophageal hiatal hernias (PEHs), resulting in a diagnostic challenge and the potential for inappropriate preoperative surgical planning. Preoperative differentiation of PHH from PEH is difficult due to their anatomic proximity to the esophageal hiatus. This report highlights the importance of intraoperative recognition of PHH and the alteration of the surgical plan. Robotic assistance was used to facilitate visualization and repair of the defect. CASE REPORT A 71-year-old female patient presented with a 3-month history of progressive epigastric pain radiating to the chest and arm, nausea, vomiting, and food intolerance. Imaging suggested a PEH, and robotic-assisted laparoscopic repair with fundoplication was planned. Intraoperatively, herniation was noted to be through a distinct diaphragmatic defect lateral to the esophageal hiatus, consistent with PHH. The PHH was complicated by a gastric volvulus. Surgical plans were adjusted to correlate with PHH repair, which included adhesiolysis and hernia reduction. A double-layer primary closure without fundoplication or mesh was performed. Recovery was uneventful, with complete symptom resolution at 2 weeks. There was no recurrence at follow-up. CONCLUSIONS PHH should be considered when intraoperative findings deviate from anticipated PEH workup. Robotic-assisted repair offers visualization and dexterity for precise dissection and secure closure. This case supports the safety and feasibility of robotic PHH repair and emphasizes intraoperative recognition to optimize surgical management.