Thoracic surgical approach for traumatic diaphragmatic hernia

Four patients with traumatic diaphragmatic hernias are reported and are discussed from the view point of surgical approach for the repair of diaphragm. All hernias were caused by car accidents and the diagnoses were made by routine radiography, computed tomography (CT) and magnetic resonance imaging (MRI) examinations. All patients were diagnosed clinically and radiologically. There was no associated intraabdominal trauma and the surgical approach was through the chest in all cases. All but 1 of the patients survived. Abdominal approach at surgery has been considered preferable because associated injuries to intra-abdominal organs have frequently been encountered in the United States. The outcomes in our series indicate that the surgical approach should be based on the clinical and radiographic findings in each indicated patient.