Minimally invasive methods of treating diaphragmatic injuries in combat trauma in hemodynamically stable patients

Abstract

Objective. To evaluate the effectiveness of laparoscopy and video-assisted thoracoscopy in the treatment of diaphragmatic injuries in patients with combined trauma who are hemodynamically stable, and to compare the results with the relevant current literature data. Materials and methods. A retrospective analysis of surgical tactics was performed in 298 hemodynamically stable patients with thoracoabdominal and abdominal injuries hospitalized in 2023–2025 who underwent minimally invasive procedures (videothoracoscopy and laparoscopy). During minimally invasive revision, diaphragmatic injuries were confirmed in 34 patients. The average time from injury to surgery was (4.5 ± 2.1) hours, and the average length of hospitalization was (5.1 ± 1.3) days. Results. Computed tomography was not sufficiently sensitive, as 11 (32.4%) diaphragmatic injuries were confirmed only during endoscopic cavity revision. Left-sided diaphragmatic defects more often required laparoscopy, while right-sided defects were mainly treated with videothoracoscopy. Minimally invasive intervention in the abdominal cavity allowed us to identify a wide range of injuries to its internal organs and restore them, including the diaphragm. In all thoracoscopic interventions, damaged lungs were repaired, hemothorax was removed, bleeding was stopped, and fragments were removed from the liver, the abdominal cavity was revised, and the diaphragm was sutured. No diaphragmatic suture failures were recorded during the observation period. Conclusions. Minimally invasive approaches provide reliable diagnosis and effective treatment of diaphragmatic injuries in combat trauma in hemodynamically stable patients. The choice of access largely depends on the side of the injury (odds ratio 7.48, p=0.031). Laparoscopy may be the method of choice for left-sided diaphragmatic injuries associated with intra-abdominal trauma. Videothoracoscopy provides better access for right-sided diaphragmatic injuries combined with blind liver damage, especially if reconstructive interventions are required for concomitant intrathoracic injuries and hemostasis of the posterior segments of the liver. Minimally invasive interventions should be included in treatment protocols for hemodynamically stable patients with combat trauma.