A 48 year old otherwise fit man presented with increasing shortness of breath on exertion. An erect chest Xray showed what seemed to be a 'raised hemi-diaphragm'. A CT scan demonstrated that the shadowing was due the presence of viscera in the chest, due to a diaphragmatic hernia either congenital or traumatic. The anterior midline location was cocsistent with a Morgagni hernia.
No muscular diaphragmatic remnant exists anteriorly into which one can reliably place a suture or fix a patch. Interrupted 2/0 Prolene sutures on a straightened needle were passed through the anterior abdominal wall, through the edge of the diaphragm and back over the costal margin, burying the knots in small cutaneous incisions.