World J Emerg Surg

. 2023 Jul 26;18(1):43.

 doi: 10.1186/s13017-023-00510-x. https://pubmed.ncbi.nlm.nih.gov/37496073/

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

Mario Giuffrida ¹, Gennaro Perrone ², Fikri Abu-Zidan ³, Vanni Agnoletti ⁴, Luca Ansaloni ⁵, Gian Luca Baiocchi ⁶, Cino Bendinelli ⁷, Walter L Biffl ⁸, Luigi Bonavina ⁹, Francesca Bravi ¹⁰, Paolo Carcoforo ¹¹, Marco Ceresoli ¹², Alain Chichom-Mefire ¹³, Federico Coccolini ¹⁴, Raul Coimbra ¹⁵, Nicola de’Angelis ¹⁶, Marc de Moya ¹⁷, Belinda De Simone ¹⁸, Salomone Di Saverio ¹⁹, Gustavo Pereira Fraga ²⁰, Joseph Galante ²¹, Rao Ivatury ²², Jeffry Kashuk ²³, Michael Denis Kelly ²⁴, Andrew W Kirkpatrick ²⁵, Yoram Kluger ²⁶, Kaoru Koike ²⁷, Ari Leppaniemi ²⁸, Ronald V Maier ²⁹, Ernest Eugene Moore ³⁰, Andrew Peitzmann ³¹, Boris Sakakushev ³², Massimo Sartelli ³³, Michael Sugrue ³⁴, Brian W C A Tian ³⁵, Richard Ten Broek ³⁶, Carlo Vallicelli ⁴, Imtaz Wani ³⁷, Dieter G Weber ³⁸, Giovanni Docimo ³⁹, Fausto Catena ⁴

Affiliations expand

• PMID: 37496073
• PMCID: PMC10373334
• DOI: 10.1186/s13017-023-00510-x

Free PMC article

Abstract

Background: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable.

Methods: A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations.

Results: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients.

Conclusions: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

Keywords: Congenital; Diaphragm hernia; Emergency surgery; Guidelines; Rupture; Trauma.

© 2023. The Author(s).