Rationale:The case of parasternal diaphragmatic hernia is relatively rare in adults. The best way for the treatment of diaphragmatic hernia is to receive operation, yet which surgical method is the best remains unclear.Patient concerns:An elderly woman in the hospital was complaining about upper abdominal pain that was complicated by the parasternal diaphragmatic hernia. Such state was found accidentally in a car accident and diagnosed by a computed tomography (CT) scan.Diagnosis:Parasternal diaphragmatic hernia.Interventions:Laparoscopic surgery was performed. The hernial component was easily drawn back into the abdominal cavity, and hernia sac was resected. Closure hernia sac underwent full-thickness U-shaped transabdominal wall sutures with 3-0 Prolene (ETHICON) after straightening the needle without a mesh.Outcomes:The patient recovered quickly without postoperative complication. The hospital stay was 2 days. There was no recurrence and symptoms at a 6-month follow-up.Lessons:Laparoscopic extracorporeal repair without using a mesh is a safe, quick, and effective approach. It seems to be an effective treatment of the parasternal diaphragmatic hernia, in particular for elderly patients.