Revista ABCd (São Paulo). 05 Jan, 2015

Laparoscopic repair in simultaneous occurrence of recurrent chronic traumatic diaphragmatic hernia and transdiaphragmatic intercostal hernia

Ismail YAMAN
Hayrullah DERICI
DOI: 10.1590/S0102-67202015000100024


Traumatic diaphragmatic hernia (TIH) develops in association with blunt or penetrating thoracoabdominal injuries. Incidence levels between 0.8% and 42% have been reported, depending on the injury site1,9,12,13. TIH is a rare entity. It occurs either due to trauma-related diaphragmatic injuries which cause tears in the intercostal muscles between the fractured ribs, or due to recurrence of diaphragmatic hernia in which previous repair was performed using the transthoracic approach1.

Traumatic diaphragmatic injuries are generally asymptomatic when isolated, and frequently cannot be detected radiologically under acute conditions13. When accompanied by other organ injuries requiring surgical exploration, diagnosis is made during operation, and these can be treated concurrently. Laparoscopic repair is usually preferred in acute isolated diaphragmatic injuries, while chronic and recurrent cases are traditionally repaired using thoracotomy because of dense adhesions. With increasing experience of minimally invasive surgery in recent years, it has been reported that chronic and recurring cases can also be laparoscopically treated.

No cases of laparoscopic repair in simultaneous recurrent chronic traumatic diaphragmatic hernia (RCDH) and TIH have been reported to date. Here, is described the laparoscopic repair of this association.

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