Abstract
This chapter examines acquired pathology of the diaphragm, including diaphragmatic relaxation or eventration of a weakened or paralyzed hemidiaphragm, tumors of the diaphragm, and esophageal hiatal hernia. Surgical management of symptomatic diaphragmatic relaxation should be considered after conservative options are exhausted, and can be completed minimally invasively with a plication procedure. Diaphragmatic tumors are rare, with secondary tumors more common than primary tumors; en bloc resection is ideal followed by simultaneous primary or mesh reconstruction of the diaphragm. We then discuss hiatal hernia anatomy and classification, risk factors, symptoms, and diagnostic modalities. Candidacy for surgery is described, and although the majority of repairs for types I through IV are completed laparoscopically, the Collis -Belsey transthoracic approach remains relevant and is described as well as postoperative management. © Springer Nature Switzerland AG 2020.