Diaphragmatic hernias can usually be surgically repaired without much difficulty by simple approximation of the edges of the defect. In a small percentage of cases, however, the tissue available for repair is inadequate or insufficient. When this occurs, ancillary surgical procedures are necessary to obliterate the defect.
Shifting the diaphragm cephalad,1 mobilization of the chest wall by thoracoplasty,2 or limited rib resection,3 may be employed to provide sufficient tissue to approximate the edges of the defect. This increases the magnitude of the procedure and may result in deformity. The experimental use of homologous tissue, such as fascia lata, has also been reported.4
In 1951, Monahan5 repaired a congenital eventration of the diaphragm, using tantalum mesh. This material tends to fragment after several months, resulting in weakening of the repair or recurrence of the defect. Nylon net has been used experimentally in dogs by Adler.6
HAUPT GJ, MYERS RN. Polyvinyl Formalinized (Ivalon) Sponge in the Repair of Diaphragmatic Defects: Report of a Clinical Case. AMA Arch Surg. 1960;80(4):613–615. doi:10.1001/archsurg.1960.01290210081016
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.