# Traumatic Diaphragmatic Hernia Treated With Minimally Invasive Abdominal and Thoracic Approach (MATA): A Case Report and Literature Review

## TL;DR

A 43-year-old woman with a traumatic diaphragmatic hernia was successfully treated using a minimally invasive abdominal and thoracic approach, supported by a literature review.

## Contribution

The paper proposes the minimally invasive abdominal and thoracic approach (MATA) as a preferred treatment for diaphragmatic hernias with strong adhesions.

## Key findings

- A left posterolateral diaphragmatic hernia was successfully diagnosed and repaired using MATA.
- Nine cases of DH treated with MATA were identified in the literature review.
- MATA is effective in releasing adhesions between herniated contents and thoracic viscera.

## Abstract

We present a 43-year-old female who presented with left chest pain on exhalation after falling in her room five days ago. CT scan of the chest also revealed a suspected complicated diaphragmatic injury in the posterolateral hernia orifice measuring 34 × 27 mm with pneumothorax. Laparoscopy was performed in the lithotomy position with the left hand raised during thoracoscopy, followed by a thoracoscopic approach. Operative findings were as follows: 1) a left posterolateral diaphragmatic hernia (DH) was diagnosed, 2) the transverse colon was herniated into the thoracic cavity and appeared difficult to reduce laparoscopically due to visceral adhesion to the left lung, 3) thoracoscopy was added to release the fibrous adhesion of the colon to the lung, and 4) the diaphragmatic repair was performed with the running suture. In addition, we performed a literature review, which identified nine cases of DH treated with a minimally invasive abdominal and thoracic approach (MATA), including our case. From this experience, MATA is proposed as the first choice to treat DH when there is strong adhesion of herniated contents to the thoracic cavity viscera.