Hand-assisted thoracoscopic repair of a Bochdalek hernia in an adult.

Background: Bochdalek hernias are congenital diaphragmatic hernias that are generally asymptomatic and often discovered incidentally. Surgical treatment is indicated once the diagnosis is made. These hernias have traditionally been repaired by open abdominal or thoracic approaches.

Methods: A healthy 24-year-old male presented with an 8-month history of shortness of breath. The patient was noted to have a postero-lateral diaphragmatic hernia, with a 4 cm defect in the left hemidiaphragm seen with computed tomography scan. He underwent hand-assisted video-assisted thoracoscopic surgery, in which the herniated omentum was reduced and the defect was repaired primarily and reinforced with Marlex mesh. The patient recovered uneventfully and was discharged home after a short hospitalization.

Conclusions: Video-assisted thoracoscopic surgery for repair of Bochdalek hernias offers diagnostic as well as therapeutic advantages as it provides an excellent view of the surgical field, is easily executed, results in minimal surgical trauma, and has excellent cosmetic results and rapid recovery. We report a hand-assisted intracorporeal thoracoscopic repair to be a secure and satisfactory adjuvant to achieve the repair and conclude that thoracoscopic repair of the rare Bochdalek hernia is feasible.