Laparoscopic repair of diaphragmatic hernia with bovine pericardium patch and opportunistic resection of metastatic thymoma.

A 57-year-old woman with known metastatic thymoma who had recently undergone a thoracotomy with resection of a diaphragmatic nodule presented with a symptomatic para-esophageal diaphragmatic hernia. She was managed with an emergency laparoscopic diaphragm repair using a bovine pericardial patch. On visualizing the thoracic cavity through the hernia defect, sub-pneumonic pleural nodules were noted. Although not the primary goal of the surgery, these nodules were resected as re-accessing the thoracic cavity would have been challenging. This case presents a novel minimally invasive approach to the management of a diaphragmatic hernia and incidentally noted metastatic thymoma.