The Probability of Diaphragmatic Injury in Left Penetrating Thoracoabdominal Traumas; Thoracotomy?, Laparotomy?, Vats?, Laparoscopy?

摘要

Objective: In this study, we aimed to present the probability of diaphragmatic injury following left thoracoabdominal traumas, diagnostic and therapeutic considerations with retrospective analysis and latest literature review.Materials and Methods: A total of 28 patients, hospitalized in our clinic between November 2005 and July 2012 due to left penetrating thoracoabdominal trauma, were retrospectively analyzed. The patients were evaluated for age, sex, diagnosis, clinical and surgical approach, diaphragmatic injury, coexistent organ injuries, duration of hospital stay and morbidity and mortality parameters.Results: Twenty-three of the patients were men (82,1%) and 5 were women (17,9%) and the mean age was 32,9 ± 11,6. Twenty-six of the patients had penetrating stab wounds (92,9%), 2 had gunshot wounds (7,1%) and just one patient had diaphragmatic injury verified by radiological studies. In some patients with penetrating stab injuries, apart from the area of the left diafragmatic trace, there were injuries in areas such as the thorax, abdomen, and the extremities. The stomach was the most commonly seen organ injury coexisting with diaphragmatic injury (10,7%). Laparotomy was performed for 18 patients (64,3%), thoracotomy for 4 patients (14,3%), thoracotomy + laparotomy for 1 patient (3,45%), and VATS for 2 patients (7,1%) and laparoscopy for 3 patients (10,8%). Left diaphragmatic injury was determined in 15 (53,6%) of the patients, while in 13 of patients (46,4%), the left diaphragm was intact. In the patients with diaphragmatic injury, 4 of them (26,7%) underwent diaphragmatic reconstruction with dual mesh and the other 11 (73,3%) underwent primary diaphragmatic repair. There was no statistically significant difference for the duration of ICU and hospital stay between the patients with diaphragmatic injury (53,6%) and those without diaphragmatic injury (46,4%), and between patients undergoing thoracotomy (14,3%) and patients undergoing laparotomy (64,3%). (P>0.05)Conclusion: To rule out the possibility of diaphragmatic injury in patients with penetrating left thoracoabdominal traumas, surgical exploration should be preferred, and if the patient is suitable, minimally invasive surgical procedures should be prc ferred.