Eventration of the diaphragm is either congential or acquired, and is characterized by extreme elevation of the diaphragm. Acquired eventration is typically associated with phrenic nerve paralysis, leading to a flaccid and atrophic diaphragm. The eventration causes paradoxical movement of the diaphragm, leads to reduced lung function causing patients to describe shortness of breath or dyspnea. If the symptoms are severe, the treatment is diaphragmatic plication which returns the diaphragm to a position of full inspiration and helps to maintain chest wall stability. Plication can be performed with an open incision and, can also be approached minimally invasively using a video assisted approach.