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
Free PMC article
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).