Hybrid Laparoscopic and Open Repair of a Transdiaphragmatic Intercostal Hernia: A Case Report

Transdiaphragmatic intercostal hernia is a rare condition that presents unique management challenges. We describe a 68-year-old morbidly obese male (BMI 40) with multiple comorbidities who underwent successful hybrid laparoscopic and open repair of a right transdiaphragmatic intercostal hernia. The hernia developed following blunt trauma 5 years earlier, which caused fractures of the right 4th-7th ribs. The patient presented with a swelling in the right flank region. CT imaging revealed a 5.9-cm diaphragmatic defect and a 10.6 x 11.9 cm intercostal defect containing small and large bowels, and omentum. Preoperative optimization included a very low-calorie diet and stabilization of diabetes, hypertension, and dyslipidemia. Surgery involved lateral decubitus positioning, customized laparoscopic port placement, an additional incision for defect closure, and laparoscopic onlay mesh placement. Recovery was uneventful, with discharge on postoperative Day 5 and no recurrence at 6 months. This case underscores the importance of meticulous preparation and hybrid techniques in managing complex hernias.