Surgical therapy of acute diaphragmatic hernia: long experience in our facilities

Abstract

Abstract Context Here, we discuss our surgical experience treating traumatic diaphragmatic hernias while attempting to determine the historical influence of various time periods on mortality risk factors and outcomes. methods From Mau 2005 to April 2022, we operated on 126 individuals who had been with traumatic diaphragmatic hernias in emergency Zagazig University Hospital. In order to show the features of the injuries, determine the best course of treatment, identify death risk factors, and compare two time periods (2010–2016 and 2016–2022) separated by the introduction of computed tomography at our institution, the patient records were examined and statistically evaluated. Results The average age of the population was 31.2 ± 16.3 years, with a ratio of 11/52 for men to women. In 38 cases (30.2%), penetrating trauma was the mechanism; in 88 cases (69.9%), blunt trauma was the cause. Computed tomography was performed on two-thirds of the patients in the second group (201 6–2022) but not on any of the patients in the first group (2010–2016). Twenty patients (15.9%), with four in the second group and sixteen in the first (p = .042), received their diagnoses later than expected. Thoracotomies were the most often performed incision (n = 86, 89.6%). Between the two periods, there was no statistically significant variation in either mortality or etiology. According to univariate analysis, survivors outnumbered non-survivors in terms of age, injury severity scores (ISS), and American Association for the Surgery of Trauma (AAST) grade. Increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were found to be risk factors for death in all patients by multivariate logistic regression analysis. In conclusion The preoperative diagnostic rate has increased dramatically with the use of high-definition computed tomography. With favorable results, the transthoracic technique may be performed in certain cases of traumatic diaphragmatic hernia. Patients who are older and have a higher ISS have a higher mortality rate.