Laparoscopic-Assisted Robotic Repair of Right Paraduodenal Hernia

Introduction Paraduodenal hernias (PDH) are internal hernias with right-sided PDHs are often more challenging. Diagnosis is usually incidental in asymptomatic patients, or patients may present with intermittent midabdominal discomfort as well as acute intestinal obstruction or strangulation. The preoperative diagnosis of PDH can be established only via cross-sectional imaging. In cases of uncertainty, diagnostic laparoscopy or laparotomy can be helpful. The surgical principles require reduction of the herniated contents, thorough assessment for viability, and closure of the hernia defect. There are case reports with laparoscopic management of paediatric PDH. However, there are no case reports of robotic repair of the adult PDH. Method A 31-year-old male patient presented to the emergency department with upper abdominal pain, distension, and bilious vomiting for two days. He had three similar episodes in the past year and was treated with conservative management. The patient was haemodynamically stable. X-ray abdomen was suggestive of small bowel obstruction. The patient was treated conservatively. CECT abdomen was done and showed closed-loop obstruction with both afferent and efferent loops trapped with a mesenteric pedicle. There was an abnormal course of the jejunal arterial branches and venous tributaries and a collection of small bowel loops in the mid-abdomen, suggesting right-sided PDH. The patient was treated electively with Robotic repair of the Right PDH. Results The intraoperative and postoperative periods were uneventful. The patient was discharged on the second postoperative day. The patient is asymptomatic at six-month follow-up. Conclusion Robotic paraduodenal hernia repair is a feasible and safe procedure.