Laparoscopic repair of missed blunt diaphragmatic rupture using a prosthesis

A 54-year-old man underwent a therapeutic laparoscopy for giant diaphragmatic rupture complicating a blunt trunk trauma that had occurred 13 months earlier. Laparoscopy revealed a left hemidiaphragm 12-cm defect with an intrathoracic herniation of the omentum, the entire gastric fundus, the splenic flexure of the colon, and the two upper thirds of the spleen. The defect was not suitable for primary suture due to the diaphragmatic edges retraction. We repaired the hernia using a large polypropylene mesh covering the defect with 2-cm overlap. There was no intraoperative surgical or anesthetic complication. Postoperative course was uneventful and 3-month follow-up confirmed the healing of the diaphragmatic hernia. This case is discussed regarding the safety of the procedure, the best minimally invasive approach, and technical aspects of the repair. Received: 6 June 1997/Accepted: 11 August 1997