Decreased Length of Stay After Laparoscopic Diaphragm Repair for Isolated Diaphragm Injury After Penetrating Trauma

Abstract

Background Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. Methods The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. Results From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications ( P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. Conclusions Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.

Diaphragmatic Injuries among Severely Injured Patients (ISS ≥ 16)—An Indicator of Injury Pattern and Severity of Abdominal Trauma

“…Their relevance could be missed when performing a primary thoracotomy. If an isolated TID following penetrating trauma is found, laparoscopic repair is feasible and seems to be superior to open repair regarding the length of hospital stay [23]. In our opin-ion, an open surgical approach should still be preferred in severely injured patients after blunt trauma, due to the high rate of intraabdominal concomitant injuries in our patient collective.…”

Laparoscopic repair of a traumatic diaphragmatic rupture

“…If immediate treatment is mandatory, the treatment of choice often was open surgery [ 14 ]. However, recent literature findings state that laparoscopic repair is just as good or even better because of increased per operative visibility and decreased post-operative pain when compared to open surgery [ 3 ]. Most of these findings include acute trauma care and little is found on patients who experience symptoms at a later stage [ 4 ].…”

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

“…3,4 Prior adult studies have demonstrated increased use and improved outcomes related to laparoscopic surgery for trauma. [5][6][7][8][9][10][11] For pediatric trauma patients, laparotomy has remained the standard for abdominal exploration and treatment; however, it is associated with an estimated 18% risk of morbidity and 5% risk of mortality. 12 Thus, more recently, increased use of laparoscopy has been employed for diagnostic evaluation of stable pediatric trauma patients as well as for therapeutic interventions including hollow viscous repair and resection.…”