Treatment of diaphragmatic ruptures by laparoscopic approach in lateral position.

Study aim: The aim of this retrospective study was to assess the feasabilit y of the treatment of recent diaphragmatic ruptures through laparoscopic ap proach in lateral position in patients with stable hemodynamic condition. Patients and method: From 1994 to 1999, seven patients, 16 to 68 years old, were operated on for diaphragmatic rupture after a 6 hours to 15 days dela y. Diaphragmatic rupture was located on the left side in 6 patients, on the right side in 1. Diagnosis was confirmed by CT-scan with reconstructions;t here was no associated visceral injury. Patients were operated on by laparo scopic approach in lateral position, herniated viscera reintegrated by mode rate pulling and diaphragmatic rupture repaired with non resorbable continu ous suture. Results: Stomach was the usual herniated viscera (n = 6); hemothorax was le ss than 300 cL; diaphragmatic rupture was 8 to 12 cm long. Duration of surg ery was no more than 120 minutes. The seven patients after a two months to two years delay had normal chest X-rays. Conclusion: The laparoscopic approach in lateral position provides good vis ibility of the diaphragmatic lesions, easy reduction of herniated organs, c omplete thorax exploration and cleaning, and easy diaphragmatic repair. Thi s technique is only feasible in patients with stable hemodynamic conditions and does not provide a complete abdominal exploration. (C) 2000 Editions s cientifiques et medicales Elsevier SAS.