The Characteristics and Surgical Approach in Post-Traumatic Diaphragmatic Hernia: A Single Center Experience.

OBJECTIVES The aim of this study was to evaluate the surgical approach in post traumatic diaphragmatic hernia. METHODS This prospective cross-sectional study was conducted  in the Department  of cardiovascular and thoracic surgery, Sher-i- Kashmir Institute of Medical Sciences (SKIMS), Kashmir, India. We included all patients with post traumatic diaphragmatic hernia undergoing operation in our center from May 2009 to November 2011. A detailed history was taken for each patient along with comprehensive general, physical, systemic and local examination of all cases. Operative findings included associated intra-abdominal injuries, and herniated intra-abdominal organs. Post-operative complications, mortality and survival were recorded and reported. RESULTS The mean age of the patients was 32±1 years and there were 16 (76.1%) men and 5 (23.8%) women among the patients. Thoracotomy was performed in 14 patients (66.7%), laparotomy in 6 patients (28.6%) and combined procedure  was used in 1 patient  (4.7%). The reduction  of hernia contents with repair of diaphragmatic rent was done in 11 (52.2%) of the patients and splenectomy with repair of rent in 6 (28.6%). Traumatic diaphragmatic hernia had 81.8% survival rate, no pre-operative mortality and 14.3% post operative mortality rate. CONCLUSION Thoracotomy is the most common approach in post traumatic diaphragmatic hernia. Laparotomy is preferred in patients having acute trauma with associated intra-abdominal injuries.