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Penetrating Right Thoracoabdominal Injuries: Do You Need to Repair the Diaphragm?
Saeram Oh1, Mary Noory1, David Trisler1
1Division of Trauma and Acute Care Surgery, Department of Surgery, East Carolina University, Greenville, NC, USA.
The American Surgeon
|May 24, 2025
Summary
Routine diaphragm repair may not be necessary for penetrating right thoracoabdominal injuries. This study found nonoperative management did not increase bile-related complications or the need for delayed surgery.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Surgical Critical Care
Background:
- Penetrating right thoracoabdominal injuries are frequently managed nonoperatively.
- The necessity of routine diaphragm repair in these cases remains uncertain.
Purpose of the Study:
- To evaluate the outcomes of nonoperative management versus surgical repair of the diaphragm in patients with penetrating right thoracoabdominal injuries.
- To determine if diaphragm repair is essential for preventing bile-related complications.
Main Methods:
- Single-center retrospective review of 37 patients with penetrating right thoracoabdominal injuries (2013-2023).
- Comparison of outcomes between patients who underwent diaphragm repair (64.9%) and those managed nonoperatively.
- Analysis of demographic data, vital signs, Injury Severity Score (ISS), and bile-related complications.
Main Results:
- No significant differences in bile-related complications (bilothorax, biliopleural fistula) between operative and nonoperative groups.
- Demographic data and ISS were similar between the groups.
- Nonoperative management was not associated with increased rates of bile-related complications or delayed thoracic surgery.
Conclusions:
- Nonoperative management of penetrating right thoracoabdominal injuries is a safe approach.
- Routine diaphragm repair may not be necessary, particularly in patients with associated liver injuries.
- Further research could refine management strategies for these complex injuries.
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