title: Laparoscopic repair of congenital diaphragmatic hernia complicated with sliding hiatal hernia with reflux in adult.
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) in adults is a relatively rare condition being asymptomatic in the majority of cases. Symptomatic CDH should prompt surgical management because they may lead to intestinal obstruction or severe pulmonary disease. This is the first reported case of a symptomatic CDH complicated with sliding hiatal hernia (SHH).
  
  
  METHODS
  A 65 years old women with reflux and dysphagia was complaining of postprandial paroxysmal dyspnea and epigastric pain radiating to her back. Upper endoscopy diagnosed sliding and para-esophageal diaphragmatic hernia with severe esophagitis. Computed tomography-scan revealed a large Bochdalek hernia at the left diaphragm.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy was decided, which confirmed the SHH, but also revealed a CDH defect at the tendonous part of the left diaphragm. The left bundle of the right crus was intact, separating the two hernia components (sliding and congenital). Extensive adhesiolysis was performed, dissecting and separating the stomach away from the diaphragm. Posterior cruroplasty at the esophageal hiatus was performed for the SHH with Nissen fundoplication as antireflux procedure. Primary continuous suture repair was performed for the CDH, reinforced with prosthetic mesh on top. Operative time was 150min with no morbidity. The patient was discharged home uneventfully the third postoperative day. On 12-months follow-up, she reported no symptoms and improvement in quality of life.
  
  
  CONCLUSIONS
  Laparoscopy is a unique method for a precise diagnosis of symptomatic congenital diaphragmatic hernia in adults being also a safe and viable technique for a successful repair at the same time. Experience of advanced laparoscopic surgery is required.
authors.affiliation: 2nd Surgical Department, Tzaneion General Hospital of Piraeus, Greece; Chicago Institute of Minimally Invasive Surgery, Skokie, IL, USA. Electronic address: gagiomam@med.uoa.gr.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Ayiomamitis
authors.forename: Panayiotis Ch
authors.initials: PCh
authors.lastname: Stathakis
authors.forename: Efstratios
authors.initials: E
authors.lastname: Kouroumpas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Avraamidou
authors.forename: Phivos
authors.initials: P
authors.lastname: Georgiades