Management of traumatic arteriovenous fistula affecting the posterior tibial artery with a PK Papyrus coronary covered stent
particularly high >50% risk of strangulation. To date, successful laparoscopic repair of adult left paraduodenal hernias has been described in 33 cases internationally. Increasing expertise in laparoscopy coupled with preoperative diagnosis on imaging has led to a trend away from laparotomy. A retrospective review by Jeong et al. showed that laparoscopic repair was more likely to result in a shorter hospital stay, earlier intake of diet, less post operative ileus and better cosmesis thereby providing a better outcome than laparotomy. We agree that laparoscopy provides superior outcomes and advocate this as an initial surgical approach. Definitive repair requires reduction of the hernia content and either direct closure or widening of the hernia orifice, the latter of which was performed in our patient. The critical step is identification and dissection of the IMV and left colic artery vessels. A traditional literature review of case reports, case series and published abstracts for laparoscopic repair describes a mean length of stay 3.4 days, a 3% incidence of recurrence and a 3% incidence of IMV injury. In summary, although paraduodenal hernias are a rare cause of intestinal obstruction, the authors recommend having a low threshold of suspicion and investigating further with CT imaging. We believe laparoscopy is safe in experienced hands and will become the initial operation of choice for the surgical management of internal hernias.
ANZ journal of surgery