Lateral approach to laparoscopic repair of left diaphragmatic ruptures

Video-assisted repairs of traumatic diaphragmatic ruptures have been descri bed where thoracoscopy or laparoscopy in the supine position were used. Thi s study aims to validate a new lateral laparoscopic approach for left diaph ragmatic repairs. Six consecutive patients were operated on for left diaphr agmatic rupture using a lateral approach (Gagner's position). A series of 3 62 consecutive patients presenting with abdominal or thoracic trauma with o r without diaphragmatic rupture over a 2-year period were reviewed retrospe ctively. Contraindications for immediate or delayed lateral laparoscopic ap proach were studied. The lateral approach provided complete visibility of t he subdiaphragmatic space, easy reduction of herniated organs, easy thoraci c inspection and cleaning, the use of low peritoneal pressure, full range o f instrumental motion, and rapid diaphragmatic repair. No operative mortali ty or morbidity was noted. Altogether, 14% to 50% of the patients with diap hragmatic ruptures were candidates for immediate lateral laparoscopic repai r. Associated spleen injury in 50% of the cases was the main contraindicati on. The lateral laparoscopic approach provides better exposure of the diaph ragm on the left side and facilitates the diaphragmatic repair especially w ith a large herniation. Immediate repair is possible in selected cases (14- 50%). There is no contraindication in case of delayed diagnosis.