1. Introduction

2. Incision and Access to the Abdomen

3. Exploration and Reduction of Small Bowel and Colon from the Chest

4. Primary Pledgeted Repair of the Diaphragm

5. Final Inspection and Hemostasis

6. Closure

7. Post-op Remarks

A diaphragmatic hernia (DH) is characterized by protrusion of abdominal organs into the chest cavity through an opening in the diaphragm. A sliding or paraesophageal hernia is the most prevalent type, characterized by its occurrence near the esophageal hiatus. Typically present since birth, it can also develop later in life, occasionally arising as a result of severe trauma or iatrogenic injury. Less often, congenital DHs protrude through posterolateral or substernal diaphragmatic defects, referred to as Bochdalek and Morgagni hernias, respectively.

DH can remain asymptomatic and is commonly detected as an incidental finding during evaluation for other medical issues. Hiatal hernias differ from abdominal wall hernias in that they are influenced by the constant motion of the diaphragm, which exerts continuous friction and pressure changes on the esophagus and the stomach. As a result, hiatal hernias have a higher likelihood of recurrence following surgical correction in comparison to abdominal hernias.

This is the case of an exploratory laparotomy for bowel obstruction and primary pledgeted repair of two diaphragmatic hernias. 

Watch this full-length, narrated surgical video of an exploratory laparotomy for bowel obstruction with primary repair of two diaphragmatic hernias.

Massachusetts General Hospital