Diaphragmatic Hernia after Thoracoabdominal Trauma - Laparoscopic Surgical Repair with Mesh

Abstract

Traumatic diaphragmatic hernia (TDH) is an uncommon disease, with an incidence of about 0.5% and is usually associated with penetrating or blunt thoracoabdominal trauma (1). It is often associated with other thoracoabdominal, brain and musculoskeletal injuries, being a diagnostic and therapeutic challenge (2). These injuries worsen the prognosis, with a mortality of up to 31% (2, 3). Chest X-rays with bowel contrast studies and CT scans of the chest and the abdomen are a useful diagnostic tool for detecting TDH, being the latter more specific (4). The treatment involves repair of the diaphragmatic defect with or without a mesh, using a transthoracic and/or transabdominal approach (1). The recurrence of diaphragmatic hernia can occur due to primary hernia repair without tension-free suture, incorrect attachment of the mesh without the necessary overlap or failure in the host-prosthesis interface (5). Hanna WC et al. demonstrated that recurrence may also be related to the use of absorbable suture to close the defect (4). The aim of this video is to illustrate the key steps for the surgical technique of a recurrent diaphragmatic hernia repair with mesh through laparoscopic approach. We present a 20-year-old male with a history of hereditary hyperferritinemia and hypertension. In 2019, due to a car accident, he suffered multiple traumas including rib fractures, descending aortic dissection, hemothorax, hemoperitoneum, and diaphragmatic laceration with the migration of the stomach to an intrathoracic position. The patient underwent thoracotomy, replacing the descending aorta isthmus with a graft, suture of the diaphragm defect, and chest drainage. Later, due to complications, he was hospitalized with a post-pericardiotomy syndrome – Dressler's syndrome - with pericardial and pleural effusion. He had a recurrence of the diaphragmatic hernia in 2021, initially small and asymptomatic, later increasing in size and becoming symptomatic. The thoraco-