Safe Repair of a Delayed Right-Sided Traumatic Diaphragmatic Hernia Using Combined Thoracoscopy and Laparoscopy: A Case Report.

Delayed traumatic diaphragmatic hernias are rare, particularly those diagnosed decades after the initial trauma. We report a case of a right-sided diaphragmatic hernia that was identified 36 years after a blunt thoracic injury and successfully treated using a combined thoracoscopic and laparoscopic approach. A 78-year-old woman presented with progressive respiratory distress. Computed tomography revealed herniation of the small intestine and right colon through a posterior diaphragmatic defect into the right thoracic cavity. Thoracoscopic and laparoscopic procedures enabled safe adhesiolysis and closure of the hernia orifice. The postoperative course was uneventful, and the patient's respiratory distress improved markedly. While both thoracic and abdominal approaches are viable for diaphragmatic hernia repair, a combined approach provided enhanced visualization and safety in this complex case. This report highlights the feasibility and benefits of a minimally invasive combined approach in the management of delayed traumatic diaphragmatic hernias.