Laparoscopic repair of posttraumatic diaphragmatic rupture. Report of three cases

Abstract

INTRODUCTIONPosttraumatic diaphragmatic rupture (PTDR) is a rare complication of thoracoabdominal injuries. In the emergency phase, it is generally treated via wide laparotomy. The laparoscopic approach is controversial and it is reserved for the chronic type of PTDR. Herein we present three cases of laparoscopic treatment of PTDR, one of which was conducted early after the injury.PRESENTATION OF CASEThe patients’ age was 42, 66 and 53 years and the time from the injury until the operation 1 week, 2 months and 4 years, respectively. Hernia involved the left hemidiaphragm in two patients and the right hemidiaphragm in the second patient. Prolapsing viscera were the omentum/stomach/spleen, the small intestine and the omentum/large bowel, respectively. The PTDR was diagnosed right after the injury of the first patient but its treatment was postponed until the fourth day of hospitalization because of severe respiratory distress due to bilateral pneumothorax, flail chest and extended bilateral lung contusions. All patients underwent laparoscopic operation and correction of the hernia with the use of non-absorbable sutures or endoclips in two patients. There were no serious intra- or postoperative complications and the patients were discharged 30, 5, 6 days after the operation. After a period of 1, 8 and 9 years, respectively the patients remain without clinical evidence of recurrence.DISCUSSIONTrauma is the major cause of acquired diaphragmatic hernias.CONCLUSIONLaparoscopy is an attractive approach for the management of chronic PTDR. Moreover, it may offer the benefits of minimally invasive surgery during the acute phase of injury in highly selected patients.

Laparoscopic Repair of Diaphragmatic Rupture: A Case Report with Radiological and Surgical Correlation

“…Though penetrating and blunt trauma to the abdomen can both result in diaphragmatic rupture, penetrating abdominal trauma is the leading cause, accounting for 75% of cases [ 3 ]. The majority of ruptures occur through the left hemidiaphragm (88–95%), as opposed to the right, because of the protective effect of the liver [ 4 ].…”

“…The diagnosis, however, can be difficult because the physical examination may be unremarkable, and 30–50% of diaphragmatic ruptures are missed on initial imaging [ 3 ]. Failure to promptly recognize diaphragmatic rupture, with subsequent herniation, can result in delayed symptoms, sometimes months and even years later, with potential catastrophic outcomes [ 5 – 7 ].…”

Laparoscopic correction of experimentally induced diaphragmatic rupture in dogs

“…Laparoscopic correction of diaphragmatic rupture in clinical settings has been reported by many authors and it is always associated with shorter hospital stay, faster return to normal activities and minimal postoperative complications [4][5][6][7][8][9][10][11][12][13] .…”

“…Since then, several authors have reported the early recovery and low incidence of postoperative complications in patients submitted to this minimally invasive approach [4][5][6][7][8][9][10][11][12][13] .…”

Diagnostic Laparoscopy for Right Hemidiaphragm Rupture With Laparotomy Repair: A Case Report

“…Surgical repair is necessary even for small defects, as the diaphragm will not spontaneously repair, and the variation in thoracic to abdominal pressures favors herniation of abdominal contents and expansion of the defect. Repair is typically performed through open laparotomy using interrupted non-absorbable sutures, but cases have been reported of laparoscopic repair [6].…”