Journal of Laparoendoscopic & Advanced surgical – Techinques The Role of Laparoscopy in the Diagnosis and the Treatment of Missed Diaphragmatic Hernia after Penetrating Trauma
Journal of Laparoendoscopic & Advanced surgical Techniques
Volume 17, Number 3, 2007
© Mary Ann Liebert, Inc.
DOI: 10.1089/lap.2005.0046
The Role of Laparoscopy in the Diagnosis and the Treatment of Missed Diaphragmatic Hernia after Penetrating Trauma
EMANUELE BALDASSARRE, MD,1 GABRIELE VALENTI, MD,1 MARCO GAMBINO, MD,2 ALESSANDRO ARTURI, MD,1 GIOVANNI TORINO, MD,2
ILARIA PROSPERI PORTA, MD,3 and MARCO BARONE, MD4
The Role of Laparoscopy in the Diagnosis and the Treatment of Missed Diaphragmatic Hernia after Penetrating Trauma
ABSTRACT
Background: The traumatic diaphragmatic hernia (TDH) may appear acutely after a blunt or penetrating trauma, or it can remain missed also for many years. The discussion about the utility of a laparoscopic repair in acute and chronic TDH is controversial.
Methods: In this paper, we present two cases of chronic TDH that were successfully treated with laparoscopy. The first patient was treated 1 year after a stab wound and the second one 10 years after a firearm injury.
Results: In both cases, the diaphragmatic defects were easily laparoscopically detected and treated. The defects were repaired with a direct running suture owing to the acceptable dimensions of the tears. The mean operative time was 135 minutes (range, 75–195). The blood loss during the opera- tions was unremarkable. No intraoperative complications occurred, and the conversion rate was null. The postoperative course was uneventful in the first patient, whereas the second patient, ow- ing to the intraoperative respiratory problems, needed an accurate respiratory monitoring in the Intensive Care Unit. The mean length of stay after the operation was 7 days (range, 6–8). At fol- low-up, the clinical examination and the chest X-rays documented no recurrence.
Conclusions: We recommend the use of laparoscopy in left chronic TDH repair, performing a di- rect suture of the diaphragm when possible.
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