Surgical tactics in treatment of traumatic raptures of the diaphragm: our experience

Abstract

Results TRD was diagnosed preoperatively in 32 patients (84%) by contrast X-Ray of gastrointestinal tract, abdominal ultrasound, and CT scan of the chest and abdomen. In 6 (16%) patients TRD was diagnosed during surgery. We did not use pleural centesis to avoid injury of abdominal organs. 27 patients (71%) underwent surgery upon 1 month of trauma episode, and 13 (34%) – after 1 month to 13 years. Right lateral thoracotomy on the 6th interspace was performed in 9 (24%) patients with right TRD. In case of large raptures the diaphragm was repaired by simple interrupted suture to chest wall on 1-2 interspaces above anatomical juncture-line which allowed repairing the diaphragm out of high tension. 11 patients (29%) with old left TRD underwent left lateral thoracotomy on the 6th interspace. In both left and right TRDs the large diaphragmatic defects were repaired by polypropylene mesh. 18 (47%) patients with acute left TRD were treated by left lateral thoracotomy accompanied by upper-medial laparotomy (11 cases) and laparoscopy (7 cases) for better examination of abdomen and restoring lesions. We observed 3 deaths (8 %) – 2 from severe craniocerebral trauma and 1 from pulmonary thromboemboli.