This video shows the case of a 36 year old male with a diaphragmatic hernia eight years after a motor vehicle accident. A large, right sided diaphragmatic hernia was evident on chest CT. The majority of the patient's small bowel, the transverse colon and liver were affected in a diaphragmatic hernia of approximately 6.5 centimeters. Adhesions are taken down with care to protect the underlying structures. Both the omentum and small bowel were reduced in a hand over hand fashion. There were few adhesions in the thoracic cavity and no hernia sac was evident. The lung was only partially inflated as a result of chronic pressure. Initial reduction of the liver was attempted via gentle retraction of the gallbladder. Ultimately the liver was reduced with retraction of the inferior lateral aspect of the liver and the gallbladder. The hernia was closed with a running barbed suture and the patient was discharged on POD 1.