Transthoracic repair of the traumatically-ruptured diaphragm is advised as there is often adhesion of abdominal viscera to the parietal peritoneum. In acute rupture, associated injuries often take precedence. In asymptomatic patients in whom other conditions simulating the presentation can be ruled out, operative repair can be delayed until definitive symptoms develop.
The actual repair is simple; once the herniated contents have been reduced, the rupture to the diaphragm can be closed with interrupted non-absorbable sutures. A chest tube should be left in the chest for a few days. This may be accomplished using a minimally invasive approach, such as laparoscopic or robotic surgery or as part of a trauma laparotomy. (1)
The prognosis following surgical repair is excellent. The diaphragm supports sutures well and recurrence is virtually unknown.
Reference
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