Laparoscopic Repair in Simultaneous Occurrence of Recurrent Chronic Traumatic Diaphragmatic Hernia and Transdiaphragmatic Intercostal Hernia

Endoscopic hemostasis of tumoral lesions is a challenging situation, since no endoscopic therapy has been proved to be superior3. Choice of therapy will be dictated by the tumor’s appearance and the personal experience of the endoscopist. Reports show that hemoclips have been applied in both successful2 and failed4 attempts to achieve hemostasis. In the present case, the tumor appeared to be friable and an attempt to apply hemoclips could have led to mucosal tearing and recurrent bleeding. Endoloop ligation of such lesions has been described to treat bleeding tumors and also to resect lesions in patients deemed nonsurgical candidates, through ischemic necrosis (loop-andlet-go)1. Although the surgical approach is considered the treatment of choice for such lesions, the endoloop technique is a useful, feasible, cheap and safe alternative for patients considered unsuitable for surgery or as a temporary measure to stabilize patients before the surgical treatment.