title: Laparoscopy in the diagnosis and repair of diaphragmatic injuries in left-sided penetrating thoracoabdominal trauma: laparoscopy in trauma.
abstract: BACKGROUND
  Diaphragmatic injuries from penetrating thoracoabdominal trauma are notoriously difficult to detect with clinical and radiological evaluation. The aim of this study was to establish the incidence of diaphragmatic injury from penetrating thoracoabdominal trauma, clinical and radiological features predictive of a diaphragmatic injury and the feasibility of laparoscopic repair.
  
  
  METHODS
  This is a prospective consecutive case series conducted in a metropolitan hospital complex. Fifty five patients were enrolled into the study and underwent a standardized laparoscopic procedure. Only stable patients were selected and right-sided penetrating thoracoabdominal injuries were excluded. The patients' clinical details, radiological findings, operative procedure, treatment of the diaphragmatic injury and complications were collected and analysed.
  
  
  RESULTS
  There were a total of 55 patients, of whom, 22 (40 %) had diaphragmatic injuries. The mean age was 26.3 ± 7.8 years (range 15-44) with a male:female ratio of 10:1. The causes of injury were stab in 54 (98.2 %) patients and firearm in one (1.8 %). Twenty six (47.3 %) patients had positive radiological findings, of which 10 (38.5 %) had a diaphragmatic injury. There were 6 (27.3 %) associated intra-abdominal injuries. Twenty one (95.5 %) of 22 patients with diaphragmatic injuries were successfully repaired laparoscopically. Mean duration of procedure with diaphragmatic repair was 74.9 ± 22.5 min compared to 38.3 ± 16.9 min without diaphragmatic repair. Six patients (10.9 %) had minor intra-operative complications. There were no deaths. Hospital stay was 2.9 ± 3.4 days.
  
  
  CONCLUSIONS
  Diaphragmatic injury was present in 40 % of patients with left-sided thoracoabdominal injury. Radiological findings were not reliable in predicting diaphragmatic injury. The majority of these injuries can be safely repaired laparoscopically.
authors.affiliation: Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu Natal, Pietermaritzburg, South Africa, mmjoli@yahoo.com.
authors.forename: Monde
authors.initials: M
authors.lastname: Mjoli
authors.forename: George
authors.initials: G
authors.lastname: Oosthuizen
authors.forename: Damian
authors.initials: D
authors.lastname: Clarke
authors.forename: Thandinkosi
authors.initials: T
authors.lastname: Madiba
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis*; D015599:Trauma Severity Indices; D014950:Wounds, Penetrating / Q000175:diagnosis*; D055815:Young Adult