Laparoscopic Repair of Diaphragmatic Hernia

Abstract

Hernias of the diaphragm are unusual defects that can present difficult diagnostic and technical problems for the surgeon (Figure 15–1). The entity of the hernia of the thoracic diaphragm was first recognized several centuries ago. Ambroise Pare (1510–1590) first described traumatic diaphragmatic hernia in 1579 based on postmortem findings in two patients [1]. In 1769, Giovanni Battista Morgagni described herniation through the subcostostemal space [2]. This same hernia would later be referred to as Larrey’s hernia [3] and descriptively known as the subcostosternal diaphragmatic hernia [4]. The posterolateral diaphragmatic hernia (foramen of Bochdalek) was described in 1848. Hiatal hernia has been recognized in autopsy studies for several centuries. Hiatal hernia was not diagnosed in living humans until early in the twentieth century following the development of diagnostic radiographic methods [5]. The technique and timing of repair of these diaphragmatic defects has been an area of controversy for many years. Recently, laparoscopic techniques have been applied to the repair of hernias of the diaphragm.