# Laparoscopic right-sided traumatic diaphragmatic hernia repair: a case report and video vignette

## TL;DR

This case report describes a rare laparoscopic repair of a right-sided traumatic diaphragmatic hernia in a 70-year-old woman, highlighting the benefits and technical challenges of the procedure.

## Contribution

The novelty lies in demonstrating a successful laparoscopic repair of a delayed, right-sided traumatic diaphragmatic hernia with detailed technical insights.

## Key findings

- Laparoscopic repair of a right-sided traumatic diaphragmatic hernia was successfully performed using a left lateral position and liver mobilization.
- The incarcerated small bowel was viable and reduced without complications, with the patient discharged on postoperative day four.
- The report emphasizes the utility of laparoscopy for diagnosis and repair, and the preference for primary closure in small defects.

## Abstract

Traumatic diaphragmatic hernias (TDHs) are uncommon and frequently missed, with right-sided defects particularly rare due to hepatic protection. Delayed presentations may result in complications including obstruction or strangulation. We present the case of a 70-year-old female with a right-sided TDH with incarceration of small bowel, 7 years following blunt trauma. Laparoscopic repair was undertaken in left lateral position, requiring mobilization of the right liver to access the posterolateral defect. Incarcerated small bowel was reduced and found to be viable. The diaphragmatic defect was closed in two layers using non-absorbable V-Loc™ sutures. The patient recovered uneventfully and was discharged on postoperative day four. This case highlights the value of laparoscopy for both diagnosis and repair, and the technical considerations required for right-sided access. Primary closure is preferred for small defects, while mesh reinforcement may be necessary in larger or chronic cases to reduce recurrence.