Chronic Post-Traumatic Diaphragmatic Hernias: Diagnostic Pitfalls, Surgical Strategies, and Long-Term Outcomes

TL;DR

Chronic post-traumatic diaphragmatic hernias are hard to diagnose and treat, often causing delayed symptoms and requiring careful surgical planning.

Contribution

This review highlights diagnostic and surgical challenges of CPDH and calls for standardized management guidelines.

Findings

Symptoms of CPDH can appear months or years after trauma, with CT being the most reliable diagnostic tool.

Minimally invasive techniques are preferred for elective repairs due to lower morbidity, though repair strategies vary.

There is a lack of consensus on surgical protocols and a need for long-term outcome research.

Abstract

Chronic post-traumatic diaphragmatic hernias (CPDH) represent uncommon clinical entities that frequently remain undiagnosed due to their wide spectrum of clinical manifestations, ranging from asymptomatic presentations to severe complications. This review explores the diagnostic difficulties, current surgical options, and long-term outcomes associated with CPDH, while highlighting the absence of consensus-based management guidelines. A review of eight published case series was performed to evaluate demographic characteristics, diagnostic delays, operative approaches, mesh use, postoperative outcomes, and recurrence rates. The findings show that symptoms may develop months or years after the initial trauma, with contrast-enhanced CT emerging as the most reliable diagnostic modality despite frequent delays in detection. Minimally invasive approaches, including laparoscopic and robotic techniques, are increasingly preferred in elective cases given their association with lower morbidity, although the choice of repair strategy and mesh material remains variable and individualized. This review emphasizes the need for heightened clinical awareness, development of standardized protocols, and further research focused on long-term outcomes and recurrence prevention.