Dual-layer sandwich mesh repair in the treatmentof major diaphragmatic eventration in an adult

Total eventration of a hemidiaphragm is a rare anomaly in adults. This condition could be subsequent to primary or acquired phrenic nerve palsy, but often it presents as a pure degenerative muscular disease without evident signs of denervation. Surgical repair is indicated only in cases of progressive exertional dyspnea, recurrent respiratory infections, or both. Routine surgical techniques counted are plication or incision, followed by double-breast suturing performed through a low posterolateral thoracotomy or minimally invasive access. We report a case of left major eventration in a 58-year-old woman in which the vanishing of most of the diaphragmatic tissue represented an extreme condition incompatible with the performance of a standard procedure.