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. 2021 Mar 19;21(1):142.
doi: 10.1186/s12893-021-01141-2.

Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

Xicheng Deng  1 , Zuosheng Deng  2 , Erjia Huang  3
Affiliations

Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

Xicheng Deng et al. BMC Surg. .

Abstract

Background: We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality.

Methods: A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution.

Results: The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005-2017) yet none in the first group (1990-2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients.

Conclusions: High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.

Keywords: CT scan; Surgery; Traumatic diaphragmatic hernia; Traumatic diaphragmatic injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

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References

    1. Sennertus R. Diaphragmatic hernia produced by a penetrating wound. Edinburgh Med Surg J. 1840;53(104):58–64.
    1. Brandt ML, Luks FI, Spigland NA, DiLorenzo M, Laberge JM, Ouimet A. Diaphragmatic injury in children. J Trauma. 1992;32(1548717):298–301. doi: 10.1097/00005373-199203000-00006. - DOI - PubMed
    1. Ward RE, Flynn TC, Clark WP. Diaphragmatic disruption secondary to blunt abdominal trauma. J Trauma. 1981;21(7463536):35–38. doi: 10.1097/00005373-198101000-00006. - DOI - PubMed
    1. Zantut LF, Ivatury RR, Smith RS, Kawahara NT, Porter JM, Fry WR, Poggetti R, Birolini D, Organ CH, Jr.: Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 1997, 42(5):825–829; discussion 829–831. - PubMed
    1. Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85(18291194):1044–1048. doi: 10.1016/j.athoracsur.2007.10.084. - DOI - PubMed

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