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Laparoscopy-assisted Repair of Diaphragm Injuries

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In this study we review our experience with an alternative laparoscopy-assisted technique for repair of diaphragm injuries. All patients admitted with an isolated diaphragm injury who underwent laparoscopy-assisted repair between January 1996 and February 2000 were included in the study. The diagnosis of the diaphragm injury was either obvious, with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. Repair of the diaphragm was performed using standard surgical instruments via a 4-cm subcostal incision with use of abdominal wall traction and the laparoscope for visualization of the defect. A total of 24 patients underwent successful laparoscopy-assisted repair; There were twenty men and four women with an average age of 28.8 years (range 23–49 years). The average Revised Trauma score was 12. There were 23 grade II and 2 grade III diaphragm injuries. The mean operative time was 61 minutes (range 25–120 minutes) and the average hospital stay from the time of surgery to the time of discharge was 2.29 days (range 1–4 days). The procedure failed in one patient as a result of gaseous distension of the bowel. One patient developed a tension pneumothorax, and two others developed atelectasis. Laparoscopic-assisted repair of isolated diaphragm injuries using abdominal wall traction and standard surgical instruments is a feasible option with minimal morbidity and no mortality.

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We are deeply indebted to Dr. Peter Bautz, past head of the Trauma Unit at Groote Schuur Hospital, who was instrumental in developing the described procedure. We also thank Dr. J. van der Spuy and Professor D. Kahn for their valuable assistance in the preparation of this manuscript.

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Correspondence to Pradeep H. Navsaria M.B.Ch.B..

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Shaw, J., Navsaria, P. & Nicol, A. Laparoscopy-assisted Repair of Diaphragm Injuries. World J. Surg. 27, 671–674 (2003).

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