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LETTER TO EDITOR |
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| Year : 2010 | Volume
: 6
| Issue : 4 | Page : 126-127 |
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Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury
Philip Umman
Department of Surgery, T D Medical College, Alappuzha, Kerala, India
| Date of Web Publication | 23-Nov-2010 |
Correspondence Address:
Philip Umman
Kochiriseril House, Nr. CMS High School, Tholassery, Tiruvalla
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.72604
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 |
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]
| ¤ References | |  |
| 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. 
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| 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.
[PUBMED] |
| 3. | Meyer G, Huttl TP, Hatz RA, Schildberg FW. Laparoscopic repair of traumatic diaphragmatic hernias. Surg Endosc 2000;14:1010-4.
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| 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.
[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.
[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.
[PUBMED] [FULLTEXT] |
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