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LETTER TO EDITOR
Year : 2010  |  Volume : 6  |  Issue : 4  |  Page : 126-127
 

Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury


Department of Surgery, T D Medical College, Alappuzha, Kerala, India

Date of Web Publication23-Nov-2010

Correspondence Address:
Philip Umman
Kochiriseril House, Nr. CMS High School, Tholassery, Tiruvalla
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.72604

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How to cite this article:
Umman P. Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury. J Min Access Surg 2010;6:126-7

How to cite this URL:
Umman P. Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury. J Min Access Surg [serial online] 2010 [cited 2020 Aug 4];6:126-7. Available from: http://www.journalofmas.com/text.asp?2010/6/4/126/72604


Dear Sir,

A policy of routine exploratory laparotomy for all patients with penetrating injury to the anterior abdominal wall will result in a significant number of negative laparotomies. [1],[2] The use of laparoscopy in the setting of trauma and for repair of acute diaphragmatic hernia has been described, though no guidelines are available, as already mentioned in the article. [3] Though bowel exploration with laparoscopy is not as thorough as with laparotomy, secondary features like significant blood in the peritoneal cavity and presence of bilious fluid can be taken as indicators of bowel injury. A high index of suspicion will enable one to convert to open procedure. This would also be based on the surgeon's experience. However, hemodynamic instability and peritonitis are strong indicators for laparotomy. [4] There are also case reports of diaphragmatic tears being missed on the initial operation. [5] Laparoscopy may also allow better visualization of diaphragmatic injuries. [6]

 
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1.Guiberteau B, Kohen M, Borde L, Sartre JY, Boourseau JC, Le Neel JC. Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases. J Chir 1992;129:420-5.  Back to cited text no. 1
    
2.Brefort JL, Samama G, Le Roux Y, Damamme A. Contribution of laparoscopy in the management of abdominal stab wounds. Ann Chir 1997;51:697-702.  Back to cited text no. 2
[PUBMED]    
3.Meyer G, Huttl TP, Hatz RA, Schildberg FW. Laparoscopic repair of traumatic diaphragmatic hernias. Surg Endosc 2000;14:1010-4.  Back to cited text no. 3
    
4.Clarke SC, Stearns AT, Payne C, McKay AJ. The impact of published recommendations on the management of penetrating abdominal injury. Br J Surg 2008;95:515-21.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Esme H, Solak O, Sahin DA, Sezer M. Blunt and penetrating traumatic ruptures of the diaphragm. Thorac Cardiovasc Surg 2006;54:324-7.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Clarke DL, Greatorex B, Osthuizen GV, Muckart DJ. The spectrum of diaphragmatic injury in a busy metropolitan surgical service. Injury 2009;40:932-7.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  




 

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2004 Journal of Minimal Access Surgery
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