Diaphragmatic hernia with Tension Gastro thorax I SAGES BEST VIDEO I Combined VATS & Laparoscopic #Generalsurgery

Diaphragmatic hernia with Tension Gastro thorax I SAGES BEST VIDEO I Combined VATS & Laparoscopic #Generalsurgery

The SAGES top video for SAGES Go Global 2016 Award – BEST International Abstract award

COMBINED LAPAROSCOPIC & THORACOSCOPIC APPROACH FOR TENSION GASTROTHORAX WITH GASTRIC VOLVULUS AMID BOCHDALEK HERNIA IN AN ADULT

We present a unique and interesting video showing, Emergent Combined Laparoscopic & Thoracoscopic Approach for Tension Gastro-thorax with Gastric volvulus amid Bochdalek hernia in a 27-year-old male.

Introduction:
Adulthood Bochdalek hernia is rare. Only 173 cases have been reported
till the year 2010.
Tension gastrothorax is further rare with only 4 adult
cases reported and none operated by endoscopy.

Management:

Conventional management of Tension Gastro thorax recommends
early gastric decompression followed by definitive surgery.

Some of these procedures can lead to contamination and sepsis
limiting use of exogenous prosthesis.

Radio imaging:
1] Chest radiograph PA ; lateral views showed large air-fluid level in left hemithorax mimicking hydropneumothorax hence a CT was imperative

2] Computed tomography axial & sagittal view showed:
Arrow shows transition line between Antral and fundic air bubbles representing
the site of volvulus.

Cine loop imaging of coronal CT showed:
Grossly distended stomach, spleen, distal pancreas and transverse colon in left
thoracic cavity with a left posterolateral diaphragmatic defect of 6.7 cm.

Resultant apical compression of left lung and right mediastinal shift was noted.

Schematic picture exemplifies cine loop imaging findings of coronal CT.

Diagnosis
– Based on clinico-radiological findings a diagnosis of Tension Gastro-thorax was established. Patient was subjected to emergency endoscopic definitive
surgery.

Conclusions:
– Tension Gastrothorax is a life threatening condition
– Emergency endoscopic definitive surgery is a safe and feasible option in young optimized patient.
-Dearth of cases Limits the Learning curve

Dr. Chintan B Patel is World renowned expert in Bariatric / Laparoscopic and General Surgery at Kiran Multi Super Speciality Hospital & Research center, Surat, Gujarat, India with more than thousand surgical cases on his name.

He has completed his MS Surgery under Prof. Dr.Girish D Bakhshi from prestigious institution, Sir J.J. Group of Hospitals , Mumbai and later joined as Assistant Professor for his further training at Sir J.J. Hospital, Mumbai with Prof. Dr.Ajay H Bhandarwar.

Special Expertise :
Bariatric (Weight Loss) & Metabolic Surgery – Obesity and Diabetes Laparoscopic Fundoplication – GERD & Hiatus Hernia -Laparoscopic Cholecystectomy – Gallbladder disease / GallStones surgery
Hernia – TEP / TAPP / IPOM – Laparoscopic repair of variety of Umbilical Ventral Hernia / Inguinal Hernia , Incisional Hernia etc
Laparoscopic Appendix and Intestinal surgeries
Hemorrhoids ( PILES ) & Fissure – Stapler , MIPH , Laser
Fistula in Ano – Fistulectomy , VAAFT, Laser, Seton
Breast surgeries – Fibroadenoma , Fibrocystic disease , Breast cancer , Mammography
Varicose Vein Surgeries – Standard / LASER / Sclerotherapy / RFA -Thyroid surgeries- TOETVA / Transaxillary / -Standard -Basic General surgeries for Lipomas , Sebecous cyst , etc
Diabetic Foot & Plastic surgeries for Diabetic Foot
Debridement

Dr. Chintan B Patel has been honored with the prestigious Society of American Gastro Endoscopic Surgeons (SAGES) award in year 2016 , 2017, 2018 consecutively at Boston , USA & Houston , USA & Seattle, USA for demonstration of various innovative techniques and research ideas in Laparoscopic , Bariatric surgery for Obesity management & Weight Loss.

Dr. Chintan B Patel is among the first surgeon doctors from India to be included in Bariatric committee of Society of American Gastro Endoscopic Surgeons (SAGES , USA) which makes standard protocols , guidelines , safety issues in Bariatric and Laparoscopic Surgery.
He has published variety of Research articles , rare case reports , presentations in various international journals , including being featured twice in Esteemed journal, BARIATRIC TIMES,Pennsylvania(USA).

Dr Chintan B Patel has dedicated his professional work to rural parts of Maharashtra as well by being part of various surgical camps organized by state government at Nashik, Nagpur, Yavatmal, Solapur, Jalgaon, Shahpur, Jawahar, Etc

Wide coverage of patients from all parts of India Like Surat I Bharuch I Bardoli I Navsari I Vapi I Daman I Baroda Vadodara I Ahmedabad I Jamnagar I Bhavnagar I Rajkot I Junagadh I Mehsana I Rajasthan I Udaipur I Indore I Mumbai I Navi Mumbai I Thane I Pune I Nashik I Nandurbar I Dhule I Malegaon I Aurangabad Global medical Coverage of patients from USA I Newyork I New Jersey I San francisco I Dubai I Yemen I South Africa I Kenya I Thailand and many other countries for best medical & surgical treatment

Best Medical Tourism Hospital & health care Support system for your hassle free medical treatment and Surgical Treatment at Kiran Hospital , Surat , Gujarat, India

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