Laparoscopic Sleeve Gastrectomy in a Patient with Agenesis of the Left Hemidiaphragm
Chandra Hassan, Luis F. Gonzalez Ciccarelli, Mario Masrur, MD1, Roberto Bustos, Antonio Gangemi, Francesco M. Bianco, Pablo Quadri, Lisa Sanchez-Johnsen, PhD, Pier Cristoforo Giulianotti
Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
•Diaphragm agenesis (DA) is the most severe form of diaphragmatic defect and a rare occurrence in adults (1).
•Incidence of 1:250,000 births (1)
•Associated with lung & cardiac anomalies (1).
•58-year-old female, BMI of 40 kg/m2 .
•Seeking bariatric surgery after reporting lifelong history of obesity.
•Pre-surgical evaluation fluoroscopy and chest x-ray showed elevation of the left hemi-diaphragm concurrent with a type II para-esophageal hernia of the stomach
•The patient elected to undergo a laparoscopic sleeve gastrectomy and a repair of para-esophageal hernia.
•A postoperative fluoroscopy showed no evidence of contrast extravasation.
•The patient was discharged tolerating a liquid diet on postoperative day one.
•Postoperative course was uncomplicated.
•At one month follow up, the patient was doing well.
•The diagnosis of asymptomatic DA remains challenging despite the thorough pre-operative diagnostic work up for bariatric surgery.
•Additional case studies in this area are needed to determine the reproducibility of our findings and the most appropriate work up to successfully diagnose DA prior to elective bariatric surgery.
1. Morosanu C et al. Prenatal diagnosis of unilateral agenesis of diaphragm and associated anomalies. Indian J PatholMicrobiol 2016;59:251-2