The experience of a single center using laparoscopic surgery for traumatic diaphragmatic injuries

INTRODUCTION: Diaphragmatic injuries are rare and occur in about 3% of all abdominal injuries. While 5% are caused by motor vehicle accidents, 10%–15% are caused by penetrating trauma. Diaphragmatic injury develops in 0.8%–7% of blunt trauma cases and 10%–15% of penetrating trauma cases. The aim of this study was to present a report of patients from a single center who underwent laparoscopic repair with the diagnosis of traumatic diaphragmatic injury during a 2-year period.
METHODS: Patients who underwent laparoscopic surgery at the study center due to traumatic diaphragmatic injury between May 2017 and November 2018 were included in the study. The demographic characteristics of the patients, cause of injury, additional injured organs, anatomical localization of the injury, surgical procedure, quantity of intraoperative hemorrhage, rate of conversion to open surgery, duration of hospitalization, morbidity and mortality rates, and 30-day readmission rate were retrospectively reviewed using hospital files and electronic records.
RESULTS: Of the patients enrolled in the study, 3 were female and 1 was male. The mean age was 47.25 years (range: 36–66 years). The injury etiology was penetrating injury for 3 patients and in-vehicle traffic accident for 1 patient. Two patients had a hemopneumothorax, which was treated with a chest tube. One patient displayed hematoma in the liver and spleen. The injury to the left diaphragm was 1–4 cm in diameter in all of the study patients. A primary repair was performed in all cases. The mean quantity of intra-abdominal bleeding was 212 mL (range: 100–300 mL) and the mean postoperative hospital stay was 7.5 days (range: 5–13 days). A postoperative intra-abdominal abscess developed in 1 patient. There was no instance of mortality and no patient was re-admitted in the 30-day period after discharge.
DISCUSSION AND CONCLUSION: It has been reported in the literature that laparoscopic approaches can be used safely in selected cases of abdominal injury, and can potentially have the benefits of laparoscopy. The results of this study also suggest that laparoscopy can be used safely in cases of traumatic diaphragmatic injury in the appropriate patients.

Travmatik diyafragma yaralanmalarýnda laparoskopik cerrahi deneyimlerimiz

GÝRÝÞ ve AMAÇ: Diyafram yaralanmalarý nadir olup, tüm abdominal yaralanmalarýn yaklaþýk %3’ünde oluþur Bunlarýn %5’ i motorlu araç kazalarý sonucu oluþurken, %10- 15’i penetran travma sonucu oluþur. Künt travmaya maruz kalan olgularda %0,8-7, penetran travmaya maruz kalan olgularda ise %10-15’inde diyafragma yaralanmasý geliþir. Bu çalýþmada, 2 yýllýk dönemde merkezimizde travmatik diyafram yaralanmasý tanýsý ile laparoskopik onarým uyguladýðýmýz hastalarý sunmayý amaçladýk
YÖNTEM ve GEREÇLER: Çalýþmamýza Mayýs 2017- kasým 2018 tarihleri arasýnda travmatik diyafram yaralanmasý sebebiyle laparospik cerrahi uyguladýðýmýz hastalar dahil edildi. Hastalarýn demografik yapýlarý, yaralanma nedeni, ek yaralanan organlar,yaralanmanýn anatomik lokalizasyonu, uygulanan cerrahi prosedür, intraoperatif hemoroji miktarýna açýða geçme oraný hastanede yatýþ süreleri, morbidite ve mortalite oranlarý 30 günlük tekrar baþvuru oranlarý retrospektif olarak dosya ve elektronik kayýtlardan incelendi
BULGULAR: Çalýþmaya katýlan hastalarýn 3’ü kadýn 1 tanesi erkekti yaþ ortalamasý 47,25 (36-66),yaralanma etyolojisi 3 hasta delici kesici alet yaralanmasý 1 hasta araç içi trafik kazasý idi,2 Hastada hemopnömotoraks vardý göðüs tüpü ile takip edildi 1 hastada karaciðerde ve dalakta hematom mevcuttu. Bütün hastalarda sol diyafragmada çapý 1-4 cm arasý deðiþen yaralanma vardý.Bütün hastalara primer onarým yapýldý Batýn içi kanama miktarý 212 ml (100-300 ml ) arasýnda idi hiçbir hastada açýða geçilmedi. Postoperatif yatýþ süreleri ortalama 7,5 gün (5- 13) idi. Bir hastada postoperatif batýn içi abse geliþti.Hiçbir hastada mortalite geliþmedi Taburculuk sonrasý 30 günlük sürede hiçbir hastada yeniden baþvuru olmadý
TARTIÞMA ve SONUÇ: Litaratürdeki çeþitli çalýþmalarda Uygun hastalarda Laparaskopik yaklaþýmlarýn güvenle uygulanabileceði ve laparoskopinin potansiyel yararlarýndan faydalanabilineceði belirtilmiþtir. Bizde uygun hastalarda travmatik diyafragma yaralanmasýndan laparaskopinin güvenle kullanýlabileceðini düþünüyoruz