Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

Mario Giuffrida, Gennaro Perrone, Fikri Abu-Zidan, Vanni Agnoletti, Luca Ansaloni, Gian Luca Baiocchi, Cino Bendinelli, Walter L. Biffl, Luigi Bonavina, Francesca Bravi, Paolo Carcoforo, Marco Ceresoli, Alain Chichom-Mefire, Federico Coccolini, Raul Coimbra, Nicola de’Angelis, Marc de Moya, Belinda De Simone, Salomone Di Saverio, Gustavo Pereira FragaJoseph Galante, Rao Ivatury, Jeffry Kashuk, Michael Denis Kelly, Andrew W. Kirkpatrick, Yoram Kluger, Kaoru Koike, Ari Leppaniemi, Ronald V. Maier, Ernest Eugene Moore, Andrew Peitzmann, Boris Sakakushev, Massimo Sartelli, Michael Sugrue, Brian W.C.A. Tian, Richard Ten Broek, Carlo Vallicelli, Imtaz Wani, Dieter G. Weber, Giovanni Docimo, Fausto Catena

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number43
JournalWorld Journal of Emergency Surgery
Volume18
Issue number1
DOIs
Publication statusPublished - Dec 2023

Keywords

  • Congenital
  • Diaphragm hernia
  • Emergency surgery
  • Guidelines
  • Rupture
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine

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