Background: Traumatic diaphragmatic hernias are a diagnostic and therapeutic challenge due to variable presentations. Early repair is important because of risks of incarceration and strangulation of herniated abdominal contents along with respiratory and cardiovascular compromise.
Objective: The purpose of the present study was to evaluate the feasibility and limitations of laparoscopic repair of acute traumatic diaphragmatic hernias.
Patients & methods: This prospective study included 7 male patients with clinically and radiologically proven traumatic diaphragmatic hernia with a mean age of 26.4±10.3; range: 16-42 years. After assuring hemodynamic stability, patients underwent laparoscopic exploration and all diaphragmatic ruptures were graded according to American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for diaphragmatic injuries. Then, identified defects were repaired laparoscopically.
Results: Diaphragmatic defects were easily detected and treated laparoscopically without need for conversion (Conversion rate 0%). The mean length of the diaphragmatic defects was 6.7±4.7; range: 1.5–15 cm. The defects were repaired with a direct running suture owing to the acceptable dimensions of the tears. The mean operative time was 105±32; range, 75–165 minutes. The blood loss during the operations was unremarkable. All surgeries were conducted safely without intraoperative complications and smooth postoperative course. The mean pain score was 4±1.3; range: 2-6. The mean duration of postoperative hospital was 4.6±3.3; range: 3–12 days. There were no documented recurrences by the clinical examination and chest X-rays after a mean follow-up period of 13.4±4.4; range: 6-18 months.
Conclusions: Laparoscopy is a safe and reliable procedure for repairing acute traumatic diaphragmatic lacerations in hemodynamically stable patients.
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