This video highlights the technical steps and difficulties in minimally invasive approaches to traumatic diaphragmatic hernias. Though uncommon this diagnosis is especially important in multi trauma as over 50% cases are diagnosed intra-operatively. The left hemi-diaphragm is involved in most cases but right-sided hernias are being increasingly diagnosed. Prompt surgical repair is the treatment of choice after utilizing appropriate diagnostic modalities.

Indications for repair include functional impairment, visceral compression or strangulation. Key steps involved include dissection of viscera and closure of the defect. Mesh or pledgets may be required in some cases. Chronic herniations may need thoracotomy.

We illustrate these principles through four cases of managed using minimally invasive approach. One case needed conversion and a mini thoracotomy because of colonic necrosis and dense adhesions in the thorax.

By proper positioning and judicious use of gravity nearly the entire diaphragm can be visualized by minimally invasive techniques. This approach also provides ability to explore other organs in stable trauma cases.

Minimally invasive approaches may be successfully used to repair stable traumatic diaphragmatic injuries with excellent exposure. These repairs can be safely accomplished with minimal morbidity though older hernias may require thoracotomy for adhesiolysis.