Laparoscopic repair of a chronic diaphragmatic hernia

Diaphragmatic injuries that remain undetected after an acute traumatic even t may lead to the formation of a diaphragmatic hernia. Symptoms of a chroni c diaphragmatic hernia are related to the incarceration of abdominal conten ts in the defect or to impingement of the lung, heart, or thoracic esophagu s by abdominal viscera. A 49-year-old woman with a symptomatic chronic diap hragmatic hernia from an unrecognized iatrogenic injury to the left hemidia phragm sought treatment, The diaphragmatic injury occurred 2 years earlier when a low, left-sided chest tube was placed for a persistent pleural effus ion 2 weeks after a lower lobectomy for an aspergilloma. The patient's diap hragmatic hernia was diagnosed after an upper gastrointestinal series and a n esophagogastroduodenoscopy. Approximately 75% of her stomach was incarcer ated in the diaphragmatic defect. The diaphragmatic hernia was repaired lap aroscopically using a 9 cm x 10-cm polytetrafluoroethylene patch sewn with nonabsorbable, interrupted, horizontal mattress sutures. Improvement of vid eo technology, laparoscopic instruments, and surgical skills has allowed su rgeons to expand the boundaries of advanced therapeutic laparoscopy. These factors facilitated the authors' standard tension-free prosthetic repair of a chronic diaphragmatic hernia using minimally invasive techniques.