Symptomatic diaphragmatic hernia: Surgical treatment

Seventy-eight cases of symptomatic diaphragmatic hernia are reported-55 hiatal (42 sliding, 9 rolling, 4 intrathoracic stomach), 19 diaphragmatic hernias proper (12 Bochdalek, 7 Morgagni) and four diaphragmatic eventrations. Pulmonary function was compromised by massive herniation in ten cases. Four hernias were incarcerated. Surgery was performed in 76 cases, as emergency in ten. Two patients were rejected because of poor pulmonary function. One patient died and three hernias recurred. The results were satisfactory in 72 cases. In sliding hiatus hernia, gastro-oesphageal reflux is the main problem and investigations should include oesophagoscopy, fluoroscopy and manometry, with treatment directed at prevention of reflux. Surgical treatment, if indicated, is usually fundoplication and dilatation of strictures. In rolling hiatus hernia and all types of diaphragmatic hernia proper, the hernia per se is the main problem, with risk of incarceration. Surgery is always indicated and should comprise reduction of hernia contents, excision of the sac and closure of diaphragmatic rift.