Diaphragmatic hernias can present as congenital defects, traumatic ruptures, or chronic incarcerations. Traditional operative repair uses simple primary suture closure or closure with muscle flaps or biomaterials via laparotomy or thoracotomy. Minimally invasive surgery has afforded surgeons new approaches to diaphragmatic defects. Most left-sided acute and chronic diaphragmatic hernias can be repaired laparoscopically. Due to limitations in tactile feedback and visualization laparoscopically, hernias that communicate with the esophageal hiatus or are in close proximity to the pericardium tend to be best suited to open repair.
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