title: Laparoscopic repair of posttraumatic diaphragmatic rupture. Report of three cases.
abstract: BACKGROUND
  Posttraumatic diaphragmatic rupture (PTDR) is a rare complication of thoracoabdominal injuries. In the emergency phase, it is generally treated via wide laparotomy. The laparoscopic approach is controversial and it is reserved for the chronic type of PTDR. Herein we present three cases of laparoscopic treatment of PTDR, one of which was conducted early after the injury.
  
  
  METHODS
  The patients' age was 42, 66 and 53 years and the time from the injury until the operation 1 week, 2 months and 4 years, respectively. Hernia involved the left hemidiaphragm in two patients and the right hemidiaphragm in the second patient. Prolapsing viscera were the omentum/stomach/spleen, the small intestine and the omentum/large bowel, respectively. The PTDR was diagnosed right after the injury of the first patient but its treatment was postponed until the fourth day of hospitalization because of severe respiratory distress due to bilateral pneumothorax, flail chest and extended bilateral lung contusions. All patients underwent laparoscopic operation and correction of the hernia with the use of non-absorbable sutures or endoclips in two patients. There were no serious intra- or postoperative complications and the patients were discharged 30, 5, 6 days after the operation. After a period of 1, 8 and 9 years, respectively the patients remain without clinical evidence of recurrence.
  
  
  CONCLUSIONS
  Trauma is the major cause of acquired diaphragmatic hernias.
  
  
  CONCLUSIONS
  Laparoscopy is an attractive approach for the management of chronic PTDR. Moreover, it may offer the benefits of minimally invasive surgery during the acute phase of injury in highly selected patients.
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Crete, Greece. Electronic address: sofiabecks@yahoo.gr.
authors.forename: Sofia
authors.initials: S
authors.lastname: Xenaki
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Lasithiotakis
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Andreou
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chrysos
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Chalkiadakis
keywords: Laparoscopy; Posttraumatic diaphragmatic rupture; Thoracoabdominal injuries
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