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The Rumel technique. An aid for difficult diaphragmatic closures.

The inherent weakness of repairing the surgically divided respiratory diaphragm is that it is a muscle to muscle closure which can easily tear. During the thoracoabdominal exposure of the thoracolumbar vertebrae, the left hemidiaphragm is divided circumferentially. Possible due to unique conditions related to these operations the diaphragm could not initially be reapproximated primarily in about 20% of the patients. A modified Rumel technique is described as an aid for closing these difficult divided diaphragms. This simple techniques succeeds by distributing the wound tension along the entire diaphragmatic suture line and not on one suture especially while being tied.