To summarize the clinical experience of laparoscopic surgical treatment for diaphragmatic hernia.

The clinical data of 10 patients with diaphragmatic hernia who underwent laparoscopic surgery at Nanjing Jiangbei Hospital between January 2022 and October 2024 were retrospectively analyzed. The key operative steps were as follows: first, reduction of the hernia contents was performed, and adhesions between the hernia ring and surrounding tissues were carefully dissected to achieve complete exposure of the defect; next, the thoracic cavity was explored, and the hernia ring was closed with non-absorbable sutures; the length of the hernia ring was then measured, and an anti-adhesion mesh was placed to overlap the weakened area by at least 3 cm; finally, the mesh was reinforced using a tacker and sutures. Postoperative recovery was assessed through outpatient visits and telephone follow-up.

All patients underwent preoperative multidisciplinary team discussion. Two patients had a Nutritional Risk Screening 2002 (NRS 2002) score ≥3 and received nutritional support. Intraoperatively, nine patients were diagnosed with left-sided diaphragmatic hernia and one with right-sided hernia. The most common hernia contents were the stomach (7 cases), colon (6 cases), and greater omentum (5 cases). The mean diaphragmatic defect area was (59.0±28.4) cm², the mean operative time was (124.5±35.9) minutes, and the median intraoperative blood loss was 25 (20, 50) ml. The hernia sac was preserved in all cases. Postoperatively, four patients required respiratory support in the intensive care unit. The most common complications were pleural effusion and pulmonary infection. All patients were discharged uneventfully. The median length of hospital stay was 11.5 (9.3, 19.0) days, and the median follow-up duration was 16.5 (13.5, 19.5) months. During follow-up, no recurrence of diaphragmatic hernia or other related complications was observed.

Laparoscopic diaphragmatic hernia repair has the advantages of thorough exploration, minimal collateral injury, and safety and reliability. Preoperative nutritional support, multidisciplinary discussion, intraoperative preservation of the hernia sac, reinforcement of the mesh, and postoperative respiratory support may contribute to improved patient recovery.