Laparoscopic Repair of Old Traumatic Diaphragmatic Hernia

Takeshi Naitoh, MD FACS, T Onogawa, MD, H Yoshida, MD, S Ottomo, MD, T Morikawa, MD, S Kimura, M Unno, MD. Department of Surgery, Tohoku University Hospital

The patient was mid 30’s year-old male. He was carried to the emergency room of our hospital with severe epigastralgia and back pain. Abdominal CT scan showed prolapsed intestine and spleen to the thoracic cavity through the diaphragmatic defect. He had a history of stung injury in his back 5 years ago and he underwent only closure of the primary wound without further examination. We speculated that this hernia was caused by the stung injury. The patient was taken to the Operating room to undergo hernia repair by laparoscopy. He was placed supine with leg split position. Five trocars were placed in the upper abdomen, and we explored the abdominal cavity with 30-degree laparoscope. Prolapsed small and large bowel were observed behind the stomach. Retrieving the bowel with careful manipulation, we could see whole spleen was also herniated into the thoracic cavity. The hernia did not have a hernia sac and the left lung was directly observed. The defect of the diaphragm was seemed linear incised scar and it was close to the stung scar of the thoracic wall. Thus we were convinced that it was old traumatic hernia caused by a stung injury. After reposition of the abdominal organ, we repaired the diaphragmatic defect with interrupted suture. The postoperative clinical course was uneventful and he discharged from hospital on 5POD. The key of this procedure is a suturing technique in narrow area and vertical situation. We present the video of this procedure.