Purpose: Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed. Results: Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented. Conclusion: This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed.

Background: The treatment of locally advanced rectal cancer (LARC) has steadily progressed over the past four decades, with recent focus shifting towards total neoadjuvant therapy (TNT). This survey aims to elucidate the perceived surgical challenges faced by Austrian colorectal surgeons performing total mesorectal excision (TME), focusing on the increased complexity and surgical difficulty introduced by intensified treatment regimens. Methods: A comprehensive survey was conducted among Austrian colorectal surgeons to explore various aspects of managing and performing TME following TNT. The survey included questions on the general management of LARC within their institutions and utilized a five-point Likert scale to assess the respondents’ perceptions and experiences regarding surgical precision and post-operative morbidity associated with TNT. Results: A total of 31 surgeons (54% response rate) completed the survey. Regarding multidisciplinary therapy preferences, 56% of respondents preferred conventional neoadjuvant therapy regimens, with 32% favoring chemoradiotherapy and 24% opting for short-course radiotherapy, while 31% chose TNT. The majority of respondents (65%) reported quality differences in tissue dissection during TME following TNT, with 57% experiencing difficulties in identifying tissue planes and 47% noting increased tissue fragility. Increased bleeding was reported by 32% of respondents. In cases of regrowth after a watch-and-wait approach, 64% observed quality changes in tissue dissection, and 47% noted tissue fragility. Conclusions: The survey results indicate that TNT impairs surgical precision due to changes in tissue quality and challenges in identifying surgical planes. Given the critical importance of surgical precision in achieving low local recurrence rates in mid-to-low LARC, these challenges could significantly impact patient outcomes. Further prospective studies are required to elucidate the extent of these effects.

Right-sided Bochdalek hernia is a mostly congenital condition of the diaphragm caused by a persistence of the pleuroperitoneal cavity and a rare disease in adults. As it often presents as an emergent situation, urgent diagnostics and surgical intervention are essential to reduce morbidity and mortality rates. Choosing the right surgical approach (abdominal, thoracic, or a combination of both) can be very challenging for clinicians. Here, we report a case of a 40-year-old woman, who presented with severe abdominal pain and tachypnoea. Imaging revealed a right-sided Bochdalek hernia. Emergency laparotomy was performed followed by reduction of hernia content, right-sided hemicolectomy, and side-to-side anastomosis from the ileum to the transverse colon due to intestinal ischemia and intrathoracic bowel perforation. The post-operative course was complicated by a pleural empyema. Therefore, the patient underwent thoracotomy. One year after surgical repair the patient had no recurrence. Here, we discuss feasible approaches for the surgical management of complicated Bochdalek hernias.

Background/Objectives: Pelvic exenteration (PE) might be a curative option for patients with advanced pelvic malignancies. Due to its significant morbidity and mortality rates, PE necessitates meticulous patient selection, and a comprehensive understanding of disease spread. This study outlines the experience at a single tertiary referral center and investigates prognostic factors influencing survival post-PE, thereby guiding clinical decision-making processes. Methods: Patients undergoing PE for advanced pelvic gynecological malignancies between 01/2016 and 12/2023 were retrospectively analyzed using a prospectively managed database. Eligibility for PE was determined through individualized tumor board evaluations based on CT/MRI imaging, excluding patients with distant metastases. Baseline demographic and clinical characteristics, operative details, complication rates, and histopathological findings were assessed using univariate and multivariate regression analyses. Disease-free (DFS) and overall survival (OS) were assessed by Kaplan-Meier analysis. Poor outcome prognostic factors were identified, outlining an optimal candidate profile for PE. Results: A total of 70 patients were included. The median age was 54.5 years. Forty-three patients (61.4%) presented with recurrent disease and the majority were diagnosed with cervical cancer (n = 48, 68.6%). Total PE was performed in 40 patients (57.1%), with complete tumor resection achieved in 68.6% of patients (n = 48). Sixteen patients (22.8%) experienced grade IV/V complications. Median DFS and OS were 8.2 and 16.4 months, respectively. Multivariate analysis identified R1 resection status and para-aortic lymph node involvement as independent negative prognostic factors. Conclusions: PE is a viable option for selected patients with advanced primary and recurrent pelvic gynecological malignancies. When complete tumor resection is feasible, patients may derive benefit from PE, although the risk of severe perioperative complications must be carefully evaluated.

Background: Surgical specialties necessitate a comprehensive understanding of anatomy. Traditional two-dimensional anatomical teaching methods lack the depth required for spatial comprehension. Virtual reality (VR)-based anatomy models offer a promising alternative, enabling an enhanced understanding of surgical topographic anatomy. This study investigated the feasibility and teaching value of VR-based surgical anatomy teaching. In addition, we explored the impact of pursuing a future surgical career. Methods: Meta Quest 2 VR system with Medicalholodeck “Anatomy and Dissection Master XR” software applications was used for virtual segmentation of a mediastinal and abdominal model annotated with anatomical terminology. The feasibility, knowledge gain, and teaching value of the VR-based topographic surgical anatomy were evaluated using a newly developed 14-item self-report questionnaire that included numeric rating scales (0–10; 0: no knowledge gain/teaching value; 10: high knowledge gain/teaching value) and dichotomous questions. Results: Thirty-seven medical students performed the instructor-guided virtual segmentation. Participants reported a high knowledge gain (median 8) and perceived teaching value (median 9) regarding complex mediastinal anatomy. Four students (11%) reconsidered their later professions after the VR sessions. Statistical analyses did not reveal any significant differences among students of different ages, genders, or educational levels. Conclusions: This study showed that the implementation of VR-based surgical topographic anatomy teaching for medical student education is feasible. As an additional tool to conventional anatomical teaching, it could enhance teaching value irrespective of age, gender, or educational level, and may influence subsequent surgical career decisions. The questionnaire requires further refinement including the standardized assessment of anatomical knowledge.