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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.
Abstract:
Patients with penetrating right thoracoabdominal injuries are often managed nonoperatively. However, it is unclear whether routine surgical repair of the diaphragm is warranted. This was a single-center retrospective review of all patients presenting to our level 1 trauma center with a penetrating right thoracoabdominal injury between 2013 and 2023. A total of 37 patients met inclusion criteria for this study. Of this group, 64.9% (24/37) underwent diaphragm repair. Demographic data including age, initial vital signs, and Injury Severity Score (ISS) were similar. When considering bile-related complications, there were no differences in the rates of bilothoraces (1/24, 4.2% vs 1/13, 7.7%, P = .7) or biliopleural fistulas (1/24, 4.2% vs 1/13, 7.7%, P = .7) between groups. Nonoperative management of penetrating right thoracoabdominal injuries was not associated with a higher rate of bile-related complications or delayed thoracic surgery suggesting that diaphragm repair in patients with concomitant liver injuries may not be necessary.
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