The diaphgram is a thin but strong sheet of muscle that separates the abdomen from the chest and plays an important role in breathing. A defect (hole) in this muscle can result in abdominal organs such as the bowel and the stomach pushing through into the chest.
There are two kinds of hernias. Congenital hernias, are those that present since birth and can be detected at any point in someone’s lifetime. These usually are a result of incomplete formation of the diaphragm during pregnancy. Whether they are detected just after birth, in childhood or even much later in life, these hernias can cause breathing problems by compressing on the lungs and the heart. Acquired hernia develops later in life, often after major injury (such as a car accident or a stabbing) where the diaphragm is torn or after certain operations, where it is cut open.
Repair
A repair is recommended as these hernias are only likely to enlarge and worsen the patients symptoms such as breathlessness. These hernias usually contain the bowel which is also at risk of getting trapped and blocked. As these are rare hernias, they are best operated by specialist surgeons.
Open or Key-hole
Key-hole is a better option for these hernias as the alternative would be a big cut across the tummy or the chest. Key-hole surgery is associated with less pain and quicker recovery. The hole in the diaphragm is initially sutured followed by coverage by a sheet of mesh for large defects. The mesh needs to extends well beyond the defect edges to ensure that the mesh is well integrated to strenghten the diaphragm.