Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study

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dc.contributor.advisorNavsaria, Pradeep Hen_ZA
dc.contributor.advisorNicol, Andrew Johnen_ZA
dc.contributor.authorMalherbe, Gideon Fen_ZA
dc.date.accessioned2015-12-04T18:10:05Z
dc.date.available2015-12-04T18:10:05Z
dc.date.issued2015en_ZA
dc.description.abstractBackground: The need to exclude occult diaphragmatic injury in left thoracoabdominal (TA) stab wounds continues to be controversial. Current trauma guidelines recommend either routine diagnostic thoracoscopy or laparoscopy and repair of an injury if found. Objective: To determine if asymptomatic patients with left sided (TA) stab wounds can be safely treated with careful clinical and chest X-ray follow up to ascertain healing of occult injuries. Methods: A parallel-group, prospective, randomized control study was conducted at the Trauma Centre at the Groote Schuur Hospital from 01 September 2009 through to 01 November 2014. All patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy to exclude a diaphragm injury, 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 from 18 to 48). The incidence of occult diaphragm injury in group A was 29%. Occult injuries found at laparoscopy were all repaired. All patients in group 2 had normal chest X-rays and no symptoms at their last visit. The mean follow up time was 24 months (range of 0 to 58). There was no morbidity nor mortality associated with the conservative management of occult diaphragmatic injuries. 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) p < 0.001, in Group B. Conclusions : Clinical and radiological follow up is feasible and appears to be safe in patients with occult diaphragm injuries after left TA stab wounds.en_ZA
dc.identifier.apacitationMalherbe, G. F. (2015). <i>Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Surgery. Retrieved from http://hdl.handle.net/11427/15603en_ZA
dc.identifier.chicagocitationMalherbe, Gideon F. <i>"Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2015. http://hdl.handle.net/11427/15603en_ZA
dc.identifier.citationMalherbe, G. 2015. Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Malherbe, Gideon F AB - Background: The need to exclude occult diaphragmatic injury in left thoracoabdominal (TA) stab wounds continues to be controversial. Current trauma guidelines recommend either routine diagnostic thoracoscopy or laparoscopy and repair of an injury if found. Objective: To determine if asymptomatic patients with left sided (TA) stab wounds can be safely treated with careful clinical and chest X-ray follow up to ascertain healing of occult injuries. Methods: A parallel-group, prospective, randomized control study was conducted at the Trauma Centre at the Groote Schuur Hospital from 01 September 2009 through to 01 November 2014. All patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy to exclude a diaphragm injury, 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 from 18 to 48). The incidence of occult diaphragm injury in group A was 29%. Occult injuries found at laparoscopy were all repaired. All patients in group 2 had normal chest X-rays and no symptoms at their last visit. The mean follow up time was 24 months (range of 0 to 58). There was no morbidity nor mortality associated with the conservative management of occult diaphragmatic injuries. 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) p < 0.001, in Group B. Conclusions : Clinical and radiological follow up is feasible and appears to be safe in patients with occult diaphragm injuries after left TA stab wounds. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study TI - Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study UR - http://hdl.handle.net/11427/15603 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15603
dc.identifier.vancouvercitationMalherbe GF. Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/15603en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Surgeryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherSurgeryen_ZA
dc.titleLaparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled studyen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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