VATS VERSUS LAPAROSCOPY TRAUMATIC DIAPHRAGMATIC INJURY REPAIR

Introduction:Diaphragmatic injury is usually missed in case

of trauma patient, clinical picture is usually masked by other abdominal or thoracic injuries. CXR (chest X ray), abdominal ultrasound have a high rate of missing. High index of suspicion is required to diagnose diaphragmatic injury.

Discussion:Comparison between 20 cases of traumatic diaphragmatic injury. Surgery is the only treatment. Different approaches are used, taking advantage of the wide spread practice of minimal invasive surgeryVATS (Video assisted thoracoscopic surgey) and laparoscopy. Overlooked injuries are usually on the right side and after blunt trauma in these cases open surgery is favoured.Prolene stitch repair (primary repair) was the main modality of repair, mesh repair was used in larger tears with poor quality tissues .Quality of life improves remarkably after repair with most patients discharged from hospital within few days.

Conclusion:VATS and Laparoscopy show efficiency in both diagnosis and treatment of diaphragmatic injuries. Conversion to open surgery may be needed in case of severe visceral injuries.Combined approach needs good communication between thoracic and general surgeonsOutcome is usually favourable with competent long term repair. Uunfavourable outcome is associated with multiple visceral organ injury and critical pre operative status.