Abstract
To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.
Highlights
Surgical treatment of traumatic diaphragmatic rupture (TDR) can be performed by both abdominal and thoracic approaches
When surgery is performed in the chronic phase of the trauma, consideration should be given to the possibility of herniation of abdominal contents into the thoracic cavity, with the possibility of adhesions between the viscera
When discussing which approach to indicate in a TDR, we find varied opinions
Summary
Surgical treatment of traumatic diaphragmatic rupture (TDR) can be performed by both abdominal and thoracic approaches. Some services still prefer the thoracic approach when they can determine by clinic and imaging methods that there was no abdominal viscera lesion. When surgery is performed in the chronic phase of the trauma, consideration should be given to the possibility of herniation of abdominal contents into the thoracic cavity, with the possibility of adhesions between the viscera. This theoretically would hamper the surgical act if the approach was abdominal, causing many surgeons to opt for the thoracic approach. Some authors report that the diagnosis of TDR is still neglected even in the intraoperative laparotomies[4,5]
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