The role of laparoscopic management in suspected traumatic diaphragmatic injury patients: A tertiary care center experience

Abstract

Background: Management of posttraumatic diaphragmatic injury (DI) is still challenging. In suspected patients with stable hemodynamic, laparoscopy may aid in the diagnosis and treatment of DI. Objective: To analyze and determine the role of laparosocopy in diagnosis and treatment of suspected diaphragmatic injury patients at Trauma Centre, Faculty of Medicine Siriraj Hospital. Material and Method: A prospective descriptive study was conducted between 2001 and 2008 in Division of Trauma Surgery, Siriraj Hospital, Mahidol University, Thailand. Twenty-four suspected DI patients with stable hemodynamic were reviewed and analyzed. Laparoscopy was performed in all patients. Results: Of the patients, 95.8% were men with a mean age of 27.3 years (range, 14-54 yr). Twenty-three patients (95.8%) had a penetrating injury. Five patients (20.8%) presented with tachypnea and decreased breath sound. Pneumohemothorax occurred in five patients (20.8%). Chest x-ray revealed diaphragmatic elevation in one patient (4.2%). Five cases (20.8%) were found DI. In one patient with right-sided DI, thoracoscopic repair was performed. There were no procedure related complications. All patients were discharged 72 hours after the operation. Conclusion: Laparoscopy is an excellent diagnostic and therapeutic tool in hemodynamically stable patients. Left-sided DI can be successfully treated with laparoscopic repair. However, right-sided DI may be better with thoracoscopic repair.