2018 Volume 51 Issue 12 Pages 806-814
The treatment strategy for a diaphragmatic injury should be considered on the premise that it is a thoracoabdominal trauma. We retrospectively reviewed cases of left traumatic diaphragmatic injury, focusing on the surgical approach. There were 9 cases encountered in our hospital and 50 cases have been reported in Japan. A total of 46 cases were treated by laparotomy as the first approach, followed by additional thoracotomy in two. Eleven cases were treated by thoracotomy as the first approach, followed by additional laparotomy in 6. Two cases were treated by thoracolaparotomy as the first approach. The outcome depended on coexistent injuries. Patients in 40 cases were alive, and 6 were dead in the laparotomy-first group. Patients in 6 cases were alive, and 5 were dead in the thoracotomy-first group. Patients in both cases were alive in the thoracolaparotomy-first group. We can afford to take the time to consider what approach should be selected for patients with a stable hemodynamic state. However, a laparotomy-first approach is generally recommended, because whether or not intervention for abdominal organ injury is immediately performed may influence the outcome. The right semi-lateral position is effective, as we can perform both laparotomy and thoracotomy approaches from this position. Furthermore, a laparotomy approach with additional thoracosopic observation can be considered to be a reasonable approach.
