title: Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax.
abstract: OBJECTIVE
  Diaphragmatic hernias (DHs) are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur.
  
  
  METHODS
  In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant.
  
  
  RESULTS
  As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax.
  
  
  CONCLUSIONS
  We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue.
authors.affiliation: Department of Surgery, University of Bonn, Bonn, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lingohr
authors.affiliation: Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Galetin
authors.affiliation: Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Vestweber
authors.affiliation: Department of Surgery, University of Bonn, Bonn, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Matthaei
authors.affiliation: Department of Surgery, University of Bonn, Bonn, Germany.
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
authors.affiliation: Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Vestweber
keywords: PERMACOL™; bilateral diaphragmatic hernia; biological implant; conventional hernia repair; diaphragm replacement; enterothorax; mesh repair