Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper
Abstract Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphr...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00510-x |
| _version_ | 1797769572716118016 |
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| author | Mario Giuffrida Gennaro Perrone Fikri Abu-Zidan Vanni Agnoletti Luca Ansaloni Gian Luca Baiocchi Cino Bendinelli Walter L. Biffl Luigi Bonavina Francesca Bravi Paolo Carcoforo Marco Ceresoli Alain Chichom-Mefire Federico Coccolini Raul Coimbra Nicola de’Angelis Marc de Moya Belinda De Simone Salomone Di Saverio Gustavo Pereira Fraga Joseph Galante Rao Ivatury Jeffry Kashuk Michael Denis Kelly Andrew W. Kirkpatrick Yoram Kluger Kaoru Koike Ari Leppaniemi Ronald V. Maier Ernest Eugene Moore Andrew Peitzmann Boris Sakakushev Massimo Sartelli Michael Sugrue Brian W. C. A. Tian Richard Ten Broek Carlo Vallicelli Imtaz Wani Dieter G. Weber Giovanni Docimo Fausto Catena |
| author_facet | Mario Giuffrida Gennaro Perrone Fikri Abu-Zidan Vanni Agnoletti Luca Ansaloni Gian Luca Baiocchi Cino Bendinelli Walter L. Biffl Luigi Bonavina Francesca Bravi Paolo Carcoforo Marco Ceresoli Alain Chichom-Mefire Federico Coccolini Raul Coimbra Nicola de’Angelis Marc de Moya Belinda De Simone Salomone Di Saverio Gustavo Pereira Fraga Joseph Galante Rao Ivatury Jeffry Kashuk Michael Denis Kelly Andrew W. Kirkpatrick Yoram Kluger Kaoru Koike Ari Leppaniemi Ronald V. Maier Ernest Eugene Moore Andrew Peitzmann Boris Sakakushev Massimo Sartelli Michael Sugrue Brian W. C. A. Tian Richard Ten Broek Carlo Vallicelli Imtaz Wani Dieter G. Weber Giovanni Docimo Fausto Catena |
| author_sort | Mario Giuffrida |
| collection | DOAJ |
| description | Abstract Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving. |
| first_indexed | 2024-03-12T21:11:01Z |
| format | Article |
| id | doaj.art-74aeab05449d464c9388a228b0477a2d |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-03-12T21:11:01Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-74aeab05449d464c9388a228b0477a2d2023-07-30T11:10:24ZengBMCWorld Journal of Emergency Surgery1749-79222023-07-0118111210.1186/s13017-023-00510-xManagement of complicated diaphragmatic hernia in the acute setting: a WSES position paperMario Giuffrida0Gennaro Perrone1Fikri Abu-Zidan2Vanni Agnoletti3Luca Ansaloni4Gian Luca Baiocchi5Cino Bendinelli6Walter L. Biffl7Luigi Bonavina8Francesca Bravi9Paolo Carcoforo10Marco Ceresoli11Alain Chichom-Mefire12Federico Coccolini13Raul Coimbra14Nicola de’Angelis15Marc de Moya16Belinda De Simone17Salomone Di Saverio18Gustavo Pereira Fraga19Joseph Galante20Rao Ivatury21Jeffry Kashuk22Michael Denis Kelly23Andrew W. Kirkpatrick24Yoram Kluger25Kaoru Koike26Ari Leppaniemi27Ronald V. Maier28Ernest Eugene Moore29Andrew Peitzmann30Boris Sakakushev31Massimo Sartelli32Michael Sugrue33Brian W. C. A. Tian34Richard Ten Broek35Carlo Vallicelli36Imtaz Wani37Dieter G. Weber38Giovanni Docimo39Fausto Catena40General Surgery Unit, Maggiore HospitalDepartment of Emergency Surgery, Maggiore HospitalResearch Office, College of Medicine and Health Sciences, UAE UniversityEmergency and Trauma Surgery, Bufalini HospitalDepartment of General Surgery, IRCCS Policlinico San Matteo FoundationGeneral Surgery, Department of Clinical and Experimental Sciences, University of BresciaJohn Hunter Hospital, University of NewcastleAcute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, University of Hawai‘IDepartment of General and Foregut Surgery, IRCCS Policlinico San Donato, University of MilanoHealthcare Administration, Santa Maria Delle Croci Hospital, AUSL RomagnaDepartment of Morphology, Surgery and Experimental Medicine, University Hospital of Ferrara and University of FerraraGeneral and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca UniversityDepartment of Surgery and Obstetrics/Gynaecology, Regional HospitalGeneral, Emergency and Trauma Surgery Department, Pisa University HospitalRiverside University Health System Medical Center, Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris CitéTrauma/Acute Care Surgery, Department of Surgery, Medical College of WisconsinDepartment of General and Metabolic Surgery, Poissy and Saint‐Germain‐en‐Laye HospitalsDepartment of General Surgery, San Benedetto del Tronto General HospitalDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp)Trauma Department, University of CaliforniaDepartment of Surgery, Virginia Commonwealth University School of MedicineDepartment of Surgery, Sackler School of Medicine, Tel Aviv UniversityDepartment of General Surgery, Albury HospitalDepartment of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical CentreDepartment of General Surgery, Division of Surgery, Rambam Health Care CampusDepartment of Primary Care and Emergency Medicine, Kyoto University Graduate School of MedicineAbdominal Center, University Hospital MeilahtiDepartment of Surgery, University of WashingtonDepartment of Surgery, Denver Health Medical Center,, University of ColoradoUniversity of Pittsburgh School of MedicineGeneral Surgery Department, Medical University, University Hospital St GeorgeDepartment of Surgery, Macerata HospitalDepartment of Surgery, Letterkenny University HospitalDepartment of General Surgery, Singapore General HospitalSurgery Department, Radboud University Medical CenterEmergency and Trauma Surgery, Bufalini Hospital Department of Minimal Access and General Surgery, Government Gousia HospitalDepartment of Trauma Surgery, Royal Perth HospitalDepartment of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”Emergency and Trauma Surgery, Bufalini HospitalAbstract Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.https://doi.org/10.1186/s13017-023-00510-xDiaphragm herniaEmergency surgeryGuidelinesRuptureTraumaCongenital |
| spellingShingle | Mario Giuffrida Gennaro Perrone Fikri Abu-Zidan Vanni Agnoletti Luca Ansaloni Gian Luca Baiocchi Cino Bendinelli Walter L. Biffl Luigi Bonavina Francesca Bravi Paolo Carcoforo Marco Ceresoli Alain Chichom-Mefire Federico Coccolini Raul Coimbra Nicola de’Angelis Marc de Moya Belinda De Simone Salomone Di Saverio Gustavo Pereira Fraga Joseph Galante Rao Ivatury Jeffry Kashuk Michael Denis Kelly Andrew W. Kirkpatrick Yoram Kluger Kaoru Koike Ari Leppaniemi Ronald V. Maier Ernest Eugene Moore Andrew Peitzmann Boris Sakakushev Massimo Sartelli Michael Sugrue Brian W. C. A. Tian Richard Ten Broek Carlo Vallicelli Imtaz Wani Dieter G. Weber Giovanni Docimo Fausto Catena Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper World Journal of Emergency Surgery Diaphragm hernia Emergency surgery Guidelines Rupture Trauma Congenital |
| title | Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper |
| title_full | Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper |
| title_fullStr | Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper |
| title_full_unstemmed | Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper |
| title_short | Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper |
| title_sort | management of complicated diaphragmatic hernia in the acute setting a wses position paper |
| topic | Diaphragm hernia Emergency surgery Guidelines Rupture Trauma Congenital |
| url | https://doi.org/10.1186/s13017-023-00510-x |
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