Laparoscopic repair of iatrogenic diaphragmatic hernia following pedicled omentoplasty using a modified Sugarbaker technique with round ligament reinforcement.

Iatrogenic diaphragmatic hernia is a rare complication following pedicled omentoplasty for post-cardiac surgery mediastinitis. No standardized repair technique has been established for this condition. We report the case of a 79-year-old man who developed an iatrogenic diaphragmatic hernia with transverse colon herniation into the mediastinum following omentoplasty after aortic arch replacement. We successfully performed a totally laparoscopic repair using a modified Sugarbaker technique with reinforcement of the peri-pedicle area using the round ligament of the liver. At 2-year follow-up, no recurrence was observed. The proposed modifications-dorsal pedicle lateralization and round ligament reinforcement of the peri-pedicle area-may improve mesh stability and reduce recurrence risk in iatrogenic diaphragmatic hernia repair while preserving the omental vascular pedicle.