Laparoscopic approach to the management of penetrating traumatic diaphragmatic injury

Tserng, Teo Li; Gatmaitan, Maria Benita

doi:10.1016/j.tcr.2017.05.010

Cited by 8 publications

(8 citation statements)

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“…The mean postoperative hospital stay was 5±3.8 days. [5][6][7][8][9][10][11][12][13] An intraabdominal abscess developed in one patient postoperatively. No patients developed postoperative mortality.…”

Section: Resultsmentioning

confidence: 98%

“…The Eastern Association for Trauma (EAST) suggested that a diagnostic laparoscopy should be considered strongly in patients with penetrating trauma to the left thoracoabdominal region without any other indication for laparotomy. [11] In their series Matthews et al [4] found the diaphragmatic defect diameter in the laparoscopic diaphragmatic injuries as 4.6 cm, the average operation time as 134.7 minutes, the mean estimated blood loss as 108.5 ml, and the postoperative length of stay was 4.4 days (range, 1-12 days). No intraoperative complications occurred in any of the patients and the most common postoperative complication was associated with the pulmonary system.…”

Section: Discussionmentioning

confidence: 98%

“…Non-absorbable 2-0 or 1-0 monofilament or braided suture is recommended in primary repair. [11] The recommended repair of traumatic diaphragmatic injury according to the degree of injury is shown in Table 2. [19] In our series, we performed primary repair because the patients were injured in Grade II-III, we did not use a patch in any patient.…”

Section: Discussionmentioning

confidence: 99%

“…Accompanying organ injuries have been reported in the literature to be 27%. [11] Many authors attributed conversion to laparotomy with accompanying organ injury, and found an average of 55%. [20][21][22] In our series, 1 patient had accompanying hematoma in the liver and spleen, and none of our patients required conversion to open surgery.…”

Section: Discussionmentioning

confidence: 99%

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Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Topal¹

2019

Laparosc Endosc Surg Sci

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Introduction: Diaphragmatic injuries are rare and occur in about 3% of all abdominal injuries. While 5% are caused by motor vehicle accidents, 10%-15% are caused by penetrating trauma. Diaphragmatic injury develops in 0.8%-7% of blunt trauma cases and 10%-15% of penetrating trauma cases. The aim of this study was to present a report of patients from a single center who underwent laparoscopic repair with the diagnosis of traumatic diaphragmatic injury during a 2-year period. Materials and Methods: Patients who underwent laparoscopic surgery at the study center due to traumatic diaphragmatic injury between May 2017 and November 2018 were included in the study. The demographic characteristics of the patients, cause of injury, additional injured organs, anatomical localization of the injury, surgical procedure, quantity of intraoperative hemorrhage, rate of conversion to open surgery, duration of hospitalization, morbidity and mortality rates, and 30-day readmission rate were retrospectively reviewed using hospital files and electronic records. Results: Of the patients enrolled in the study, 3 were female and 1 was male. The mean age was 47.25 years (range: 36-66 years). The injury etiology was penetrating injury for 3 patients and in-vehicle traffic accident for 1 patient. Two patients had a hemopneumothorax, which was treated with a chest tube. One patient displayed hematoma in the liver and spleen. The injury to the left diaphragm was 1-4 cm in diameter in all of the study patients. A primary repair was performed in all cases. The mean quantity of intra-abdominal bleeding was 212 mL (range: 100-300 mL) and the mean postoperative hospital stay was 7.5 days (range: 5-13 days). A postoperative intra-abdominal abscess developed in 1 patient. There was no instance of mortality and no patient was re-admitted in the 30-day period after discharge. Conclusion: It has been reported in the literature that laparoscopic approaches can be used safely in selected cases of abdominal injury, and can potentially have the benefits of laparoscopy. The results of this study also suggest that laparoscopy can be used safely in cases of traumatic diaphragmatic injury in the appropriate patients.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Topal¹

2019

Laparosc Endosc Surg Sci

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“…10 In penetrating diaphragmatic injuries, laparoscopic repair is the preferred option for stable patients. 11…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Splenectomy for Trauma

Shamim¹,

Zafar²,

Nizam³

et al. 2018

JSLS

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Background and Objectives:The use of laparoscopy in the trauma setting is gaining momentum, with more therapeutic procedures being performed. We evaluated the use of laparoscopic splenectomy among trauma patients with data from the National Trauma Database. We compared outcomes for trauma patients undergoing laparoscopic (LS) versus open splenectomy (OS).Methods:From the National Trauma Database (2007 to 2015), we identified all patients who underwent a total splenectomy. Patients who had other abdominal operations were excluded. All patients were categorized into 1 of 2 groups: LS or OS. Outcomes of in-hospital mortality, postoperative length of stay, and incidence of major complications between the 2 groups were compared. Bivariate parametric and nonparametric analyses were performed. Patients were then matched on baseline demographic and injury characteristics by using propensity score matching techniques, and we compared differences by using regression analysis.Results:A total of 25,408 patients underwent OS and 113 patients underwent LS (0.44%). Patients were significantly different at baseline, with the LS group being less severely injured. Bivariate analysis revealed no difference in length of stay (9 vs 8 days, P = .62), incidence of major complications (10% vs 15%, P = .24), or mortality (6% vs 11%, P = .23). LS was performed in 29.2% of patients beyond 24 hours from presentation compared with 9.5% in the OS (P < .001). Adjusted multivariate analysis showed no overall difference in outcomes.Conclusion:LS for trauma is increasingly being used at many centers throughout the United States. The procedure is safe, with outcomes similar to those of OS in selected trauma patients.

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