Laparoscopy or clinical follow-up to detect occult diaphragm injuries following left-sided thoracoabdominal stab wounds: A pilot randomized controlled trial

  • Gideon Malherbe University of Cape Town
  • Pradeep H Navsaria University of Cape Town
  • Andrew J Nicol University of Cape Town
  • Sorin Edu University of Cape Town
  • Sharfuddin Chowdhury University of Cape Town
Keywords: penetrating, thoracoabdominal, diaphragm, laparosscopy

Abstract

Background: The purpose of this study was to determine whether patients with left-sided thoracoabdominal (TA) stab wounds can be safely treated with clinical and chest X-ray follow up.

Method: A prospective, randomized control study was conducted at Groote Schuur Hospital from September 2009 through to November 2014. Patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy and Group B underwent clinical and radiological follow-up.

Results: Twenty-seven patients were randomized to Group A (N=27) and thirty-one to Group B (N=31). All patients were young males with a median age of 26 years (range 18 to 48). The incidence of occult diaphragm injury in Group A was 29%. All diaphragm injuries found at laparoscopy were repaired. The mean hospital stay for the patients in Group A was 5 days (SD 1.3), compared to a mean hospital stay of 2.9 days (SD, 1.5), in Group B (p < 0.001). All patients in Group B had normal chest X-rays at their last visit. The mean follow-up time was 24 months (median: 24; interquartile range: 1–40). There was no morbidity or mortality in Group B.

Conclusions: Clinical and radiological follow-up are feasible and appear to be safe, in the short term, in patients who harbour occult diaphragm injuries after left TA stab wounds. Until studies showing the natural history of diaphragm injury in humans are available, laparoscopy should remain the gold standard in treatment.

Author Biographies

Gideon Malherbe, University of Cape Town

Trauma Centre
Groote Schuur Hospital
University of Cape Town
Cape Town

Pradeep H Navsaria, University of Cape Town

Trauma Centre
Groote Schuur Hospital
University of Cape Town
Cape Town

Andrew J Nicol, University of Cape Town

Trauma Centre
Groote Schuur Hospital
University of Cape Town
Cape Town

Sorin Edu, University of Cape Town

Trauma Centre
Groote Schuur Hospital
University of Cape Town
Cape Town

Sharfuddin Chowdhury, University of Cape Town

Trauma Centre
Groote Schuur Hospital
University of Cape Town
Cape Town

Published
2017-11-16
How to Cite
Malherbe, G., Navsaria, P., Nicol, A., Edu, S., & Chowdhury, S. (2017). Laparoscopy or clinical follow-up to detect occult diaphragm injuries following left-sided thoracoabdominal stab wounds: A pilot randomized controlled trial. South African Journal of Surgery, 55(4), 20-25. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2064
Section
Trauma