Diaphragmatic bilateral post-traumatic ruptures are uncommom and technically challenging to repair. Traumatic rupture of the diaphragm has a reported incidence between 0.8% and 7% of all patients after blunt trauma. Clinical manifestations vary on which organ herniates into the thorax and on the extent of herniation. Laceration or hernia must be repaired. Treatment remains controversial with many avaible prosthetic meshes. The approach depends on many points.

A 73 year old female had an automobile accident twenty years ago with blunt abdominal and thoracic trauma. Ten years later she reported abdominal pain and four episodes of acute pancreatitis until 2008. Image studies in 2008 showed abdominal organs herniated through the left diaphragm into the thorax and an hepatic segment through into the right thorax. An ellective laparoscopy treatment was decided. The patient was respectively placed at the full lateral position in the opposite side of the hernia. We used four trocars along each subcostal margin. A 38.5 cm² parietex^TM mesh closed the left defect with stapler and reinforced by non-absorbable endosuture, after phrenotomy. Non-absorbable suture treated the right diaphragm. Chests were drained.

Laparoscopic treatment was completed without complications and with its advantages. Post-operative image studies showed discrete alterations at anatomic landmarks. Outcome was unremarkable with hospital delivery at the sixth post-operative day.

Laparoscopy was a useful and excellent technique, safely and affectively applied to this kind of diaphragmatic hernia. We based on a multidisciplinary detailed and decisive study of the exams, experienced surgeons, appropriated hospital, technological advanced video equipment and advanced laparoscopic techniques.