Laparoscopic repair of traumatic diaphragmatic injuries

Background. Laparoscopy has been proposed as a diagnostic and potentially t herapeutic modality for penetrating diaphragmatic lacerations. The purpose of this study was to assess the technical feasibility and strength of vario us laparoscopic repairs of diaphragmatic injuries. Methods. Swine underwent either open suture repair or laparoscopic repair b y staple, suture, or patch technique of a 2-cm laceration to both the right and the left muscular or tendinous diaphragmatic leaflets. Six weeks after operation, diaphragms were harvested for either histologic analysis or bur sting strength measurements. Results. All methods of repair proved technically feasible. There was no si gnificant difference in bursting strength measurements between treatment gr oups. Bursting was due to tissue failure either at or adjacent to the repai r site. Histologic analysis confirmed healing of all specimens with the lap aroscopic patch technique inciting less inflammation and greater fibroblast ic proliferation than the other techniques. Conclusions. Laparoscopic repair of diaphragmatic lacerations can be accomp lished using any of the currently available techniques. Laparoscopic stapli ng, suturing, or patch techniques all result in complete healing with a str ong and durable repair. When selecting a particular technique, familiarity of the surgeon should be used as a guideline. (C) 2001 Academic Press.