International Surgery Journal | May 2020 | Vol 7 | Issue 5 Page 1627 International Surgery Journal Chauhan SS et al. Int Surg J. 2020 May;7(5):1627-1633 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Series Thoraco-laparoscopic management of diaphragmatic hernia of adults: a case series Siddharth S. Chauhan 1 , Ajit Mishra 2 , Sandeep Dave 3 *, Jawwad Naqvi 3 , Siddharth Tamaskar 3 , Vikram Sharma 3 , Nitin Niwas 3 INTRODUCTION The diaphragmatic hernia is a herniation of abdominal viscera within the pleural space through a diaphragmatic defect; it can be either acquired or congenital. 1 Acquired hernias are most commonly traumatic in origin and may be due to penetrating or blunt thoracoabdominal trauma. Rarely, spontaneous acquired hernia without any symptom may be occurred. 2 Spontaneous diaphragmatic hernia is an uncommon entity that accounts for <1% of diaphragmatic hernia ruptures. 3 The clinical features depend on location of hernia, the organ herniated through it and timing of presentation. Diagnosis may be delayed by several months or even years. A sceptical approach, combined with thorough history, physical examination and a correct interpretation of the chest x-ray, are very important in diagnosis. In situations of uncertain diagnosis a CT scan chest and abdomen can be of great help. The timing of operation usually is decided by the patient’s symptoms. For patients who have incarcerated hernia, urgent repair is necessary. For those patients in whom the hernia is found incidentally, an elective repair can be performed. Amongst the various surgical approaches the minimally invasive technique (laparoscopic and thoracoscopic approach) gives safe, feasible, effective alternative along with it’s all the advantages of being minimally invasive surgery. ABSTRACT Diaphragmatic hernia (DH) usually occurs in childhood; however, in adult it is uncommon. Most common aetiology of DH in adult is trauma while spontaneous DH is a rare entity accounting for <1%. The management is primarily surgical repair in the form of open or laparoscopic approach; the later has been associated with low morbidity, mortality and excellent long term outcomes with low rate of recurrence. In this case series, confirmation of the diagnosis was done by CT scan and by laparoscopy in all the patients; laparoscopic repair was performed in all the patients along with thoracoscopic aid in two cases. We found that minimal access techniques can be safely done in DH; in conditions when the herniated content are difficult to get reduced laparoscopically alone, a simultaneous thoracoscopy has helped in great deal in reducing the content and completing the procedure entirely by minimal access techniques. This gives all the advantages of minimally invasive approach like less postoperative pain, shorter hospital stay, quicker recovery and low recurrence rate; provided tissue repair is done in tension free manner by an experienced laparoscopic surgeon. Keywords: CT scan chest and abdomen, Diaphragmatic hernia, Laparoscopy, Thoracoscopy 1 Department of Minimal Access Surgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India 2 Department of GI Surgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India 3 Department of General Surgery and Department of Minimal Access Surgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India Received: 04 March 2020 Revised: 03 April 2020 Accepted: 07 April 2020 *Correspondence: Dr. Sandeep Dave, E-mail: dr.siddharth.tamaskar@carehospitals.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20201882