Minimally invasive approach in diaphragmatic injuries due to stab wounds: 10 years of experience

Yıl 2023, , 490 - 496, 29.12.2023

Menduh Oruc Serdar Onat Atalay Şahin , İsmail Yıldız

https://doi.org/10.5798/dicletip.1411517

Öz

Objective: We aimed to evaluate minimally invasive methods in the diagnosis and treatment of stabbing diaphragmatic injuries.
Methods: Between January 2013 and January 2023, 66 patients with suspected diaphragmatic injury (DI) due to stab wounds, were diagnosed and treated with video assisted thoracoscopic surgery (VATS). The records of age, gender, concomitant injuries, surgical approach, morbidity and length of hospital stay were reviewed retrospectively.
Results: The mean age of the patients was 26.39 years and they were 59 males and 7 females. Of the patients, 42 (63.4%) were on the left side and 24 (36.4%) were on the right side. According to the sites, The wounds were anterior in 32 (48.5%) of the cases and posterior in 34 (51.5%). Concomitant injuries were seen in 47 cases. DI was confirmed in 30 (45.5%) cases. Of these, 18 (60%) were on the left and 12 (40%) were on the right. The surgeries were VATS alone in 36 (54.5%), VATS via stab wounds in 22 (33.3%), and mini-thoracotomies in 8 (12.1%) of the cases, respectively. DI was confirmed in 30 (45.5%) cases. Eighteen (60%) of them were on the left, and 12 (40%) were on the right (p0.05). The mean duration of hospital stay was 4.58 days in anterior injuries and 6.11 days in posterior injuries. No patient died.
Conclusıon: As a minimally invasive method, VATS is the method of choice for the detection and treatment of DI in thoracoabdominal injuries caused by stabbing.

Anahtar Kelimeler

minimally invasive approach, stabbing, diaphragma, injuries

Kaynakça

• 1.Maish MS. The diaphragm. SurgClin North Am.2010; 90(5):955-68. doi:10.1016/j.suc.2010.07.005.
• 2.Lim BL, Teo LT, Chiu MT, et al. Traumaticdiaphragmatic injuries: a retrospective review of a12-year experience at a tertiary trauma centre.Singapore Med J. 2017; 58(10):595-600. doi:10.11622/smedj.2016185.
• 3.Al-Koudmani I, Darwish B, Al-Kateb K, et al. Chesttrauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: aretrospective review of 888 cases. J CardiothoracSurg. 2012(19);7:35. doi: 10.1186/1749-8090-7-35.
• 4.McDonald AA, Robinson BRH, Alarcon L, et al.Evaluation and management of traumaticdiaphragmatic injuries: A Practice ManagementGuideline from the Eastern Association for theSurgery of Trauma. J Trauma Acute Care Surg. 2018;85(1):198-207. doi:10.1097/TA.0000000000001924.
• 5.Martinez M, Briz JE, Carillo EH. Videothoracoscopy expedites the diagnosis and treatment of penetrating diaphragmatic injuries. SurgEndosc.2001; 15(1):28-32; discussion 33. doi:10.1007/s004640002090.
• 6.Meteroğlu F, Şahin A, Başyiğit İ, et al.Torakstravmasıtakibindedikkatedilmesigerekendurum: Diyafragmayaralanmaları [Diaphragmaticinjury: condition be noticed in the management ofthoracic trauma]. Ulus TravmaAcilCerrahiDerg.2015; 21(6):514-9. Turkish. doi:10.5505/tjtes.2015.30660.
• 7.Chen JC, Wilson SE. Diaphragmatic injuries:recognition and management in sixty-two patients.Am Surg. 1991; 57(12):810-5.
• 8.Turhan K, Makay O, Cakan A, et al. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg. 2008; 33(6):1082-5. doi: 10.1016/j.ejcts.2008.01.029. Epub 2008 Mar 4.
• 9.Ganie FA, Lone H, Lone GN, et al. Delayedpresentation of traumatic diaphragmatic hernia: adiagnosis of suspicion with increased morbidity andmortality. Trauma Mon. 2013; 18(1):12-6. doi:10.5812/traumamon.7125.
• 10.Yucel M, Bas G, Kulalı F, et al. Evaluation ofdiaphragm in penetrating left thoracoabdominalstab injuries: The role of multislice computedtomography. Injury. 2015; 46(9):1734-7. doi:10.1016/j.injury.2015.06.022.
• 11.İlhan M, Bulakçı M, Bademler S, et al. Thediagnostic efficacy of computed tomography indetecting diaphragmatic injury secondary tothoracoabdominal penetrating traumas: acomparison with diagnostic laparoscopy. UlusTravmaAcilCerrahiDerg. 2015; 21(6):484-90. doi:10.5505/tjtes.2015.94389.
• 12.Lowdermilk GA, Naunheim KS. Thoracoscopicevaluation and treatment of thoracic trauma.SurgClin North Am. 2000; 80(5):1535-42. doi:10.1016/s0039-6109(05)70243-7.
• 13.Yanık F, Karamustafaoğlu YA, Yörük Y. The roleof VATS in the diagnosis and treatment ofdiaphragmatic injuries after penetrating thoracictraumas. Ulus TravmaAcilCerrahiDerg. 2020;26(3):469-474. English. doi:10.14744/tjtes.2019.02682.
• 14.Freeman RK, Al-Dossari G, Hutcheson KA,et al.Indications for using video-assisted thoracoscopicsurgery to diagnose diaphragmatic injuries afterpenetrating chest trauma. Ann Thorac Surg. 2001;72(2):342-7. doi: 10.1016/s0003-4975(01)02803-x.
• 15.Petekkaya S, Ayaz N, Doğan M, Oruç M, OkdemirE, Celbis O. Early Stage Pulmonary EmbolismBecause of Stab Wound Injury Without VascularPenetration. J Emerg Med Case Rep 2017; 8: 76-9.
• 16.Paci M, Ferrari G, Annessi V, et al. The role ofdiagnostic VATS in penetrating thoracic injuries.World J Emerg Surg. 2006; 5(1):30. doi:10.1186/1749-7922-1-30.