Laparoscopic Diaphragmatic Hernia Repair in the Adult Patient

Jessica Ardila Gatas, MD; Matthew T. Allemang, MD; Jeffrey L. Ponsky, MD, MBA, FACS; James P. Villamere, MD; John H. Rodriguez, MD, FACS

Product Details
Product ID: ACS-5584
Year Produced: 2018
Length: 8 min.


Non-hiatal diaphragmatic hernias are uncommon in the adult patient. We present two modalities for laparoscopic repair. A 57-year-old female with a history of erroneously diagnosed dextrocardia and morbid obesity (BMI 40), who was incidentally found to have a large left diaphragmatic hernia while being work-up for bariatric surgery. A large left Morgagni diaphragmatic defect was identified containing transverse colon and omentum. The hernia sac was reduced and excised at the diaphragmatic border. The defect was closed primarily and a polypropylene mesh was secured with surgical glue and nonabsorbable tacks. The patient was discharged on postoperative day 2. She subsequently underwent a sleeve gastrectomy several months later and the diaphragmatic repair was found to be intact with no recurrence. The second case is a 70 year old male who presented with symptoms of gastric outlet obstruction. Imaging showed a large Morgagni diaphragmatic hernia with concern for volvulus. In the operating room, a massive bilateral foramen of Morgagni diaphragmatic hernia containing his entire stomach with volvulus in the chest was found. The stomach was fully reduced and the edge of the hernia sac was reduced and resected. Significant tension precluded primary suture repair. A dual sided polypropylene mesh was used for a tension free repair. Intracorporeal, transfascial sutures and surgical glue were used to anchor the mesh. The patient was discharged on postoperative day 3. Laparoscopic diaphragmatic hernia repair is safe, feasible, and effective in the elective and emergent setting. Different techniques are available, depending on the surgeon expertise and anatomic variability.