Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Abstract

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.

Is diagnostic laparoscopy necessary in the management of left thoracoabdominal stab wounds?

“…Diaphragmatic rupture increases conversion to open surgery, operation duration, complication rate, and hospital stay in the literature. [ 20 ] However, in our study, we did not find a significant difference between the two groups, whereas the duration of operating time was significantly higher in the diaphragmatic injury group.…”