Welcome to the Penetrating Thoracoabdominal / Traumatic Diaphragmatic Injury Module

This ALL-SAFE module will allow surgeons to become confident and competent in the laparoscopic management of a diaphragmatic laceration.

Why Penetrating Thoracoabdominal Trauma?

The incidence of occult diaphragmatic injury in the setting penetrating thoracoabdominal trauma is as high as 43%. [1] Even with robust imaging options, a missed rate of occult traumatic diaphragmatic injury is as high as 50%. In developed countries, hemodynamically stable patients with penetrating thoracoabdominal injuries are routinely approached laparoscopically. However, most patients in the low-resource setting are treated through exploratory laparotomy, an operation with significant morbidity and mortality. The increased morbidity of the open approach to treat occult diaphragmatic injury is compounded in the lower resource setting by the higher rates of trauma injury in general and the weaker system with which to treat them. The general benefits of laparoscopy over open surgery include decreased operation time, perioperative blood loss, length of stay, infection rate, and convalescence time and would translate to meaningful positive gains in health outcomes, economics, and healthcare utilization for populations. [2]


The adoption of laparoscopy for the evaluation and treatment of penetrating thoracoabdominal trauma resulting in diaphragmatic injury would significantly decrease the morbidity for these patients who currently undergo exploratory laparotomy. [3] While this module will address the specific surgical management of a diaphragmatic injury laparoscopically, the technical principles taught in this case (diagnostic laparoscopy, retraction, exposure, intracorporeal suturing and knot tying) are general and widely applicable towards laparoscopy and a surgical practitioner’s laparoscopic toolkit.

References

  1. Koto, Z.M., Mosai, F. & Matsevych, O.Y. The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed. World J Emerg Surg 12, 27 (2017). https://doi.org/10.1186/s13017-017-0137-2
  2. Obaid O, Hammad A, Bible L, Ditillo M, Castanon L, Douglas M, Anand T, Nelson A, Joseph B. Open Versus Laparoscopic Repair of Traumatic Diaphragmatic Injury: A Nationwide Propensity-Matched Analysis. J Surg Res. 2021 Dec;268:452-458. doi: 10.1016/j.jss.2021.07.022. Epub 2021 Aug 17. PMID: 34416418.
  3. Ali Yahya, Hussein Shuweiref, Ahmed Thoboot, Mustafa Ekheil & Abdulmajid A Ali (2008) Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital, Libyan Journal of Medicine, 3:3, 138-139, DOI: 10.3402/ljm.v3i3.4777


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