Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

Abstract

Background:The incidence of missed diagnosis of traumatic diaphragmatic injury (TDI) is about 30%.Lower rib fractures may cause TDI. We aimed to present our clinical results of uniportal video-assisted thoracoscopic surgery (VATS) in terms of detecting and repairing TDI, in patients undergoing rib fixation. Materials and Methods:In this retrospective study, routine uniportal VATS was performed in patients planned to undergo rib fixation due to flail chest and severely displaced rib fractures between January 2021 and January 2023. The results of 11 patients with TDI were investigated.Results: All patients were male. Eighty-two percent of the patients had blunt type of injury. Most TDIs were detected during VATS (55%). There were 7 left and 4 right TDIs with diaphragmatic defects varying from 2 to 5 cm in size. Two patients had minor omental herniation. Mean number of fractured ribs was 4.Mean duration of operation was 139 minutes. Mean hospital stay was 7 days. Morbidity developed in 1 patient (9%, wound infection).Conclusions: Routine VATS in patients undergoing SSRF helps detecting and repair TDIs. Its diagnostic benefit in the diagnosis of acute TDI is greatest in patients with multiple rib fractures involving the lower chest wall, although there are no radiographic evidences of TDI.