Failure of Open Traumatic Diaphragm Rupture Repair Managed by Robotic-Assisted Laparoscopic Approach
Recommended Citation
Rogozinski T, Alrashid O, Qureshi H, Coughlin J. Failure of Open Traumatic Diaphragm Rupture Repair Managed by Robotic-Assisted Laparoscopic Approach. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Blunt traumatic diaphragmatic rupture is an uncommon but potentially life-threatening injury frequently associated with intra-abdominal trauma. Operative exploration is typically required to evaluate associated injuries and perform repair. While delayed or chronic cases often favor a transthoracic approach, minimally invasive strategies for early postoperative failure of primary repair are not well described.
Description:
A 40-year-old male presented after a motor vehicle collision. Computed tomography revealed a left-sided diaphragmatic rupture with gastric herniation into the thoracic cavity. Associated pelvic and sacral fractures were managed non-operatively. He underwent exploratory laparotomy with reduction of the herniated stomach and primary two-layer repair using running 0 Prolene suture. A left-sided chest tube was placed. On postoperative day three, he developed recurrent chest pain and intolerance of oral intake. Imaging demonstrated recurrent gastric herniation consistent with repair failure. Given the short interval from the index operation and anticipated minimal adhesions, a robotic-assisted transabdominal re-repair was performed. Intraoperative esophagogastroduodenoscopy confirmed gastric viability and allowed decompression. Using a four-port robotic technique, prior suture material was removed and minimal adhesions were encountered. The defect was closed with interrupted, pledgeted 0 Ethibond horizontal mattress sutures, reinforced with a running 2-0 Stratafix layer. Mesh was not used, and the defect was closed without tension. The patient tolerated the procedure well without perioperative complications. No hernia recurrence was noted on follow-up.
Discussion:
Traumatic diaphragmatic rupture requires prompt repair to prevent visceral strangulation and respiratory compromise. Early failure of primary repair is uncommon but challenging. Reoperation is often performed via a transthoracic approach in delayed cases with dense adhesions. In this case, early recognition allowed minimally invasive reintervention before significant adhesion formation. The robotic-assisted transabdominal approach provided excellent visualization and precise suturing, enabling durable two-layer closure without mesh. Robotic repair is a feasible option for early postoperative diaphragmatic repair failure in selected patients and may reduce morbidity associated with thoracotomy while maintaining sound reconstructive principles.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
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Failure of Open Traumatic Diaphragm Rupture Repair Managed by Robotic-Assisted Laparoscopic Approach
Background/Significance:
Blunt traumatic diaphragmatic rupture is an uncommon but potentially life-threatening injury frequently associated with intra-abdominal trauma. Operative exploration is typically required to evaluate associated injuries and perform repair. While delayed or chronic cases often favor a transthoracic approach, minimally invasive strategies for early postoperative failure of primary repair are not well described.
Description:
A 40-year-old male presented after a motor vehicle collision. Computed tomography revealed a left-sided diaphragmatic rupture with gastric herniation into the thoracic cavity. Associated pelvic and sacral fractures were managed non-operatively. He underwent exploratory laparotomy with reduction of the herniated stomach and primary two-layer repair using running 0 Prolene suture. A left-sided chest tube was placed. On postoperative day three, he developed recurrent chest pain and intolerance of oral intake. Imaging demonstrated recurrent gastric herniation consistent with repair failure. Given the short interval from the index operation and anticipated minimal adhesions, a robotic-assisted transabdominal re-repair was performed. Intraoperative esophagogastroduodenoscopy confirmed gastric viability and allowed decompression. Using a four-port robotic technique, prior suture material was removed and minimal adhesions were encountered. The defect was closed with interrupted, pledgeted 0 Ethibond horizontal mattress sutures, reinforced with a running 2-0 Stratafix layer. Mesh was not used, and the defect was closed without tension. The patient tolerated the procedure well without perioperative complications. No hernia recurrence was noted on follow-up.
Discussion:
Traumatic diaphragmatic rupture requires prompt repair to prevent visceral strangulation and respiratory compromise. Early failure of primary repair is uncommon but challenging. Reoperation is often performed via a transthoracic approach in delayed cases with dense adhesions. In this case, early recognition allowed minimally invasive reintervention before significant adhesion formation. The robotic-assisted transabdominal approach provided excellent visualization and precise suturing, enabling durable two-layer closure without mesh. Robotic repair is a feasible option for early postoperative diaphragmatic repair failure in selected patients and may reduce morbidity associated with thoracotomy while maintaining sound reconstructive principles.
Affiliations
Advocate Lutheran General Hospital