The role of laparoscopy in the diagnosis and the treatment of missed diaphragmatic hernia after penetrating trauma.
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 operations 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, owing 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 follow-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 direct suture of the diaphragm when possible.
Baldassarre
Emanuele
E
Department of General Surgery, San Pietro Hospital--Fatebenefratelli, Rome, Italy. emanuele.baldassarre@uniromal.it
Valenti
Gabriele
G
Gambino
Marco
M
Arturi
Alessandro
A
Torino
Giovanni
G
Porta
Ilaria Prosperi
IP
Barone
Marco
M
D000328:Adult; D002908:Chronic Disease; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000628:therapy; D013536:Suture Techniques; D013898:Thoracic Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications; D014950:Wounds, Penetrating / Q000150:complications*; D014951:Wounds, Stab / Q000150:complications