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


METHODS
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.


CONCLUSIONS
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.
Opasanon
Supaporn
S
Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. anne_surgeon@hotmail.com
Akaraviputh
Thawatchai
T
Keorochana
Kris
K
Somcharit
Lertpong
L
D000293:Adolescent; D000328:Adult; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult