Clinical Outcomes and Surgical Management of Traumatic Diaphragmatic Injuries: A 10-Year Retrospective Analysis

Abstract

Background: Diaphragmatic injuries (DIs) are uncommon but life-threatening consequences of both blunt and penetrating thoracoabdominal trauma that may be difficult to diagnose. This study aimed to evaluate the demographic characteristics, injury mechanisms, surgical approaches, and outcomes of patients who underwent surgical management for DI during the study period.
Materials and Methods: We retrospectively reviewed the medical records of 20 patients treated surgically for traumatic DI between January 2015 and December 2025. Data on age, sex, mechanism and side of injury, associated organ injuries, surgical techniques, and postoperative outcomes were analyzed.
Results: The study group consisted of 17 males (85%) and 3 females (15%), with a mean age of 42.5±19.82 years. The mechanisms of injury was included penetrating trauma in 11 patients, including 10 stab wounds and 1 gunshot wound, and blunt trauma in 9 patients. Right-sided and left-sided injuries were equally distributed with 10 patients in each group. While computed tomography (CT) suggested DI in 60% of cases (n=12), the remaining 7 patients were diagnosed intraoperatively during surgery for associated pathologies. The surgical approaches included video-assisted thoracoscopic surgery (VATS) in 11 patients (55%), thoracotomy in 8 (40%), and laparotomy in 1 (5%). Primary repair was performed in 17 patients and one patient required prosthetic mesh reinforcement. Associated organ injuries were present in 9 patients (45%). The mortality rate was 10% (n=2), primarily due to concomitant injuries and shock. Conclusions: Diaphragmatic injuries remain a diagnostic challenge due to the lack of specific symptoms and the limited sensitivity of imaging. Clinical suspicion is vital when radiological findings are inconclusive. VATS is a reliable and effective minimally invasive tool for both the diagnosis and treatment of DI. In our limited cohort, both deaths occurred in patients with severe associated injuries and hemodynamic instability.

Keywords

• Diaphragmatic injury
• Trauma
• Video-assisted thoracoscopic surgery
• Thoracotomy
• Surgical repair

Supporting Institution

None

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of Sivas Cumhuriyet University Faculty of Medicine (approval no: 226-01/114, date: January 29, 2026).

Thanks

None

Travmatik Diyafram Yaralanmalarının Klinik Sonuçları ve Cerrahi Yönetimi: 10 Yıllık Retrospektif Bir Analiz

Abstract

Amaç: Diyafragma yaralanmaları (DY), hem künt hem de penetran travmalar sonrası gelişebilen, tanısı zor ve hayati tehlike oluşturan yaralanmalardır. Bu çalışmada, kliniğimizde 10 yıllık süreçte diyafragma yaralanması nedeniyle cerrahi tedavi uygulanan hastaların demografik özelliklerini, yaralanma mekanizmalarını, cerrahi yaklaşımları ve sonuçlarını değerlendirmeyi amaçladık.
Materyal ve metod: Ocak 2015 ile Aralık 2025 tarihleri arasında travmatik DY tanısıyla opere edilen 20 hastanın verileri retrospektif olarak incelendi. Hastaların yaş, cinsiyet, yaralanma mekanizması, yaralanma tarafı, ek organ yaralanmaları, cerrahi teknikler ve postoperatif sonuçları analiz edildi.
Bulgular: Hastaların 17’si (%85) erkek, 3’ü (%15) kadın olup; yaş ortalaması 42,5±19,82 idi. Yaralanmaların %50'si kesici delici alet yaralanması, %45'i künt travma ve %5'i ateşli silah yaralanması sonucu gelişmişti. Yaralanmaların taraf dağılımı sağ ve sol hemidiyafragma için eşitti (%50 - %50). Bilgisayarlı tomografi (BT) hastaların %60'ında (n=12) DY tanısı koydururken; 7 hastada DY, ek patolojiler nedeniyle yapılan operasyonlar sırasında saptandı. Cerrahi yaklaşım olarak %55 oranında (n=11) video yardımlı torakoskopik cerrahi (VATS), %40 (n=8) torakotomi ve %5 (n=1) laparotomi uygulandı. Hastaların 17'sine primer sütürasyon yapılırken, bir hastada prostetik mesh kullanıldı. Dokuz hastada (%45) ek organ yaralanması mevcuttu. Ortalama hastanede yatış süresi 14,6 gün olarak saptandı. İki hasta (%10) ek organ yaralanması ve şok tablosu nedeniyle hayatını kaybetti.
Sonuç: Diyafragma yaralanmaları spesifik semptomların yokluğu nedeniyle tanısal zorluklar içermeye devam etmektedir. Radyolojik bulguların yetersiz kaldığı durumlarda klinik şüphe esastır. VATS, hem tanı koymada hem de tedavide güvenilir ve etkin bir minimal invaziv yöntemdir. Her iki ölüm de ciddi eşlik eden yaralanmaları ve hemodinamik instabilitesi olan hastalarda meydana gelmiştir.

Keywords

• Diyafragma yaralanması
• Travma
• VATS
• Torakotomi
• Cerrahi onarım

Supporting Institution

Yok

Ethical Statement

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Clinical Research Ethics Committee of Sivas Cumhuriyet University Faculty of Medicine (approval no: 226-01/114, date: January 29, 2026).

Thanks

Yok

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