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The feasibility and efficacy of laparoscopic repair for chronic traumatic diaphragmatic herniation: introduction of a novel technique with literature review

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Abstract

Purpose

Traumatic diaphragm rupture is a rare trauma that is easily overlooked. A missed diagnosis would result in chronic traumatic diaphragmatic herniation (CTDH). Surgical repair is the standard treatment that is conventionally performed by laparotomy or thoracotomy. Laparoscopic repair has been reported, but its efficacy remains controversial. In this study, we present our novel technique and experience of laparoscopic repair of CTDH and analyze the feasibility and effectiveness of this procedure.

Methods

We conducted a prospective collection with retrospective review of patients with CTDH treated at Chang Gung Memorial Hospital, Taiwan, from 2000 to 2013. The demographic characteristics, surgical procedure, perioperative results, length of hospital stay (HLOS) and follow-up were record and analyzed.

Results

There were 114 patients with traumatic diaphragm hernia, and 24 of them had CTDH with a mean age of 54.9 ± 13.3 years. The HLOS was 15.08 ± 8.17 days. Regarding the surgical method used, 19 patients had open surgery, and 5 patients underwent laparoscopic surgery. The demographic distribution, trauma mechanism, location and size of CTDH were comparable. In the laparoscopic group, the patients had a shorter median HLOS (6 days) than in the open surgery group (16 days; p = 0.002). There was no mortality or recurrence in both groups.

Conclusions

In this study and literature review, patients had laparoscopic repair with a smooth recovery. Laparoscopy provides good surgical exposure, allowing easy repositioning of the herniated content and a smooth repair of the defect without the morbidity of laparotomy. For CTDH, with caution, we can apply this technique with an acceptable result.

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Acknowledgments

The authors thank F.-P. Kuo, C.-J. Chen and H.-F. Tien as Members of the CGMH Trauma Registry Databank, which is acknowledged for its contribution to data collection of the research.

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    Authors and Affiliations

    1. Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan

      C.-H. Liao, Y.-T. Wu, C.-Y. Fu, F.-J. Hsieh, S.-Y. Wang, Y.-P. Hsu & S.-C. Kang

    2. Department of General surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan

      C.-H. Chu

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    1. C.-H. Liao
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    2. C.-H. Chu
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    3. Y.-T. Wu
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    4. C.-Y. Fu
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    5. F.-J. Hsieh
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    7. Y.-P. Hsu
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    8. S.-C. Kang
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    Correspondence to C.-Y. Fu.

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    All of our authors have no conflict of interest or financial ties to disclose.

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    C.-H. Liao and C.-H. Chu have equally contributed to this manuscript.

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    Liao, CH., Chu, CH., Wu, YT. et al. The feasibility and efficacy of laparoscopic repair for chronic traumatic diaphragmatic herniation: introduction of a novel technique with literature review. Hernia 20, 303–309 (2016). https://doi.org/10.1007/s10029-015-1405-2

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    • DOI: https://doi.org/10.1007/s10029-015-1405-2

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