The use of laparotomy in the treatment of recent diaphragmatic rupture due to blunt trauma.

The choice of approach is still one of the most controversial points in the surgical treatment of recent rupture of the diaphragm. Most authors agree, however, about the use of thoracotomy in the late cases with strangulation. From 1970 to 1982 inclusive, 40 patients were operated on within a week of closed rupture of the diaphragm. The following data appear from these operations: 1. In 29 patients (73 per cent) one or more subdiaphragmatic organs needed repair. Only 4 patients (10 per cent) required operation for a thoracic lesion. 2. The hernia was easily repaired in the 34 cases treated by laparotomy only. For this reason when confronted by a recent diaphragmatic rupture, we almost always use an abdominal incision knowing that it, can easily be extended into the chest if this becomes necessary for the treatment of an injury there. In our experience, this policy needed to be changed in only a very few special cases.