Surgical Management: Other Diaphragmatic Hernias in Adults

The diaphragm is an anatomically complex organ composed of muscular and tendinous portions with a rich neurovascular network. An intact and functioning diaphragm is critical for respiration, and it serves as a barrier between the chest and abdominal cavities. Diaphragmatic hernias not located at the esophageal hiatus can either be congenital (Morgagni or Bochdalek hernias) or traumatic (either accidental or postoperative) in nature. Abdominal organs may be pulled into the thoracic cavity through any diaphragmatic defect, encouraged by the pressure differential between the chest and abdomen. In general, in patients with reasonable operative risk, any diaphragmatic hernia should be repaired when diagnosed. Surgical repair of non-hiatal diaphragmatic defects can be either transabdominal or transthoracic and may incorporate minimally invasive techniques. Repair often includes primary tissue apposition, due to the redundancy of diaphragmatic muscular tissue. When mesh is required, most surgeons prefer a nonporous mesh material. Postoperatively, the diet can be restarted immediately. Long-term recurrence is unusual following repair.