Advances in Surgical and Therapeutic Strategies for Diaphragmatic Hernias: A Comprehensive Review

• DOI: https://doi.org/10.22533/at.ed.1594932415102

• Palavras-chave: Diaphragmatic hernia repair; Minimally invasive surgery; Synthetic and biological meshes; Robotic-assisted thoracoscopy; Postoperative outcomes.

• Keywords: Diaphragmatic hernia repair; Minimally invasive surgery; Synthetic and biological meshes; Robotic-assisted thoracoscopy; Postoperative outcomes.

• Abstract: INTRODUCTION Diaphragmatic hernias, both congenital and acquired, are significant clinical challenges that have historically been associated with high morbidity and mortality rates. This article explores the progression of treatment methodologies, focusing on the shift from traditional open surgeries to modern minimally invasive and robotic-assisted techniques. Additionally, the introduction highlights the role of advanced imaging, mesh technology, and future innovations such as stem cell and gene therapies. OBJETIVE   To provide a comprehensive analysis of the latest advancements in the therapeutic and surgical management of diaphragmatic hernias, emphasizing the role of minimally invasive techniques, the use of synthetic and biological meshes, and innovative approaches such as stem cell and gene therapies. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Diaphragmatic Hernia” AND “Minimally Invasive Surgery” OR “Robotic-Assisted Surgery” OR “Surgical Meshes” OR “Postoperative Care” in the last  years. RESULTS AND DISCUSSION The article discusses various advancements in diaphragmatic hernia repair, including the use of laparoscopic and robotic-assisted techniques that have reduced postoperative complications and recovery times. Comparative studies between synthetic and biological meshes were reviewed, showing their relative merits in reducing recurrence rates. Emerging technologies such as 3D modeling, advanced imaging, and tissue engineering are highlighted for their role in improving surgical outcomes. Additionally, advances in postoperative care, including enhanced recovery protocols and telemedicine, are examined as significant contributors to patient recovery. The use of stem cell therapy and gene editing is proposed as a future avenue for improving tissue regeneration and repair. CONCLUSION The future of diaphragmatic hernia management is promising, driven by advancements in minimally invasive surgery, robotic-assisted technologies, and regenerative medicine. While short-term outcomes for patients have improved significantly, long-term studies are needed to assess the durability of current techniques and materials, particularly in large and complex hernias. Innovations in imaging, mesh technology, and postoperative care will likely continue to shape the field, with a multidisciplinary approach essential for optimizing patient outcomes.