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Challenges in trauma and acute care surgery
LAPRA-TY for laparoscopic repair of traumatic diaphragmatic hernia without intracorporeal knot tying
  1. Jeff Choi1,
  2. Jenny Pan1,
  3. Joseph D Forrester2,
  4. David Spain2,
  5. Timothy D Browder2
  1. 1 General Surgery, Stanford University, Stanford, California, USA
  2. 2 Department of Surgery, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Jeff Choi, General Surgery, Stanford University, Stanford, CA 94305, USA; jc2226{at}stanford.edu

Abstract

Case Presentation A 38-year-old man was brought in by ambulance as a trauma activation after sustaining a self-inflicted stab wound in the left upper quadrant with a kitchen knife. His primary survey was unremarkable and his vital signs were normal. Secondary survey revealed a 2 cm transverse stab wound inferior and medial to the left nipple. Extended focused assessment with sonography for trauma (FAST) did not show intra-abdominal or pericardial fluid and chest X-ray did not show a definite pneumothorax or hemothorax.

What would you do?

  1. Wound exploration at bedside.

  2. Admit for observation and serial examinations.

  3. Exploratory laparotomy and open repair of traumatic diaphragmatic injury (TDI).

  4. Thoracotomy and open repair of TDI.

  5. Diagnostic laparoscopy and laparoscopic repair of TDI.

  • diaphragm
  • surgical technique
  • trauma laparoscopy
  • penetrating trauma

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000334

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    Footnotes

    • Contributors JC and JP contributed equally to the work; drafted, wrote and revised the work. JP, JF, DS and TB were involved in the use of the technique during the surgery. JF, DS and TB contributed to final revisions of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.