Laparoscopic Repair of a Chronic Traumatic Diaphragmatic Hernia

Etienne Auger-Dufour, MD, Gerald Fried, MD, Liane Feldman, MD, Lorenzo Ferri, MD PhD. Montreal General Hospital, McGill University Health Center

Case presentation
This video demonstrates the laparoscopic repair of a chronic traumatic diaphragmatic hernia in a 44 year-old female patient. She had a motor vehicle crash fifteen years ago. She is now presenting with abdominal pain worse with eating and intermittent episodes of vomiting. Chest x-ray, barium swallow and CT scan images are shown. A left diaphragmatic defect in which the fundus of the stomach is incarcerated is found.
Operative technique
Initially, the stomach is partially reduced from the hernia cavity. The left triangular hepatic ligament is taken down with the harmonic scalpel to improve the exposition. Adhesions between the stomach and the left intrathoracic structures are divided. The stomach is fully reduced into the peritoneal cavity. The left crus and the esophagus are identified. The size of the defect is evaluated. A dual-sided PTFE mesh is inserted and deployed. Sutures and tacks are used to secure the mesh to the diaphragm circumferentially around the hernia defect. A 2 cm overlap is accomplished.
Postoperative evolution
The postoperative course is briefly described and a chest x-ray done at 1 year postop shows no recurrent hernia.

Session: VidTV1
Program Number: V063

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