Operative techniques for repair of various types of diaphragmatic hernia.

Abstract

In the surgical repair of diaphragmatic hernia, this question frequently arises: What operative technique should be utilized, and should the approach be abdominal or thoracic? The surgeon who repairs diaphragmatic hernias should be familiar with the pathological anatomy of the various types of hernia and applicable techniques of repair, as well as capable of utilizing either an abdominal or a thoracic approach, the choice of which depends on the individual patient's problem. The operative techniques described here were found to be most satisfactory in the repair of various types of diaphragmatic hernias occurring in 109 patients observed from 1935 to 1956. The embryonic development of the diaphragm, which is from several different segments fusing to form one structure, containing three natural openings, contributes to developmental anomalies, weak areas, or actual defects. There may be improper fusion, lack of firmness, or absence of an entire leaf, resulting in either a weakened