Diaphragmatic Hernia
- Verres or Hasson entry, 30° camera, & triangulate ports on target anatomy.
- Open gastrohepatic ligament, identifying and preserving vagal branches & any aberrant hepatic arteries.
- Position liver retractor.
- Bluntly dissect crura circumferentially from esophagus, reduce any herniated contents, excise any sac, identify & preserve the vagi.
- Make window posterior to esophagus while preserving posterior vagus.
- Mobilize gastric fundus using a Ligasure to divide the short gastrics to the angle of His.
- Use Penrose to retract esophagus.
- Close crura over a 56Fr bougie with 2-0 Ethibond horizontal mattress sutures at 1 cm intervals.