The Role of Laparoscopic Management in Suspected Traumatic Diaphragmatic Injury Patients: A Tertiary Care Center Experience†
Supaporn Opasanon MD*, Thawatchai Akaraviputh MD**, Kris Keorochana MD*, Lertpong Somcharit MD*
Affiliation : † Presented at the 11th World Congress of Endoscopic Surgery, September 2nd-5th, 2008, Yokohama, Japan * Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Endo-laparoscopic Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Material and Method: 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.
Conclusion : 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.
Keywords : Diaphragmatic injury, Laparoscopic repair
