Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

中文翻译：

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急性情况下复杂性膈疝的治疗：WSES 意见书

急性膈疝 (DH) 可能会危及生命。其管理仍存在争议。使用主要数据库进行书目检索，使用术语“紧急手术”、“膈疝”、“外伤性膈疝”和“先天性膈疝”。GRADE 方法用于评估证据并提出建议。胸部和腹部CT扫描是评估复杂DH的诊断金标准。适当的术前评估和及时的手术干预对于临床成功非常重要。复杂的 DH 修复最好通过使用生物和生物可吸收网片进行，这些网片已被证明可以减少复发。对于血流动力学稳定、无明显合并症的患者，腹腔镜手术是首选技术，因为它有助于早期诊断胸腹部创伤性伤口造成的小膈肌损伤，并减少术后并发症。开腹手术应保留在没有腹腔镜检查技能和设备、需要剖腹探查或患者血流动力学不稳定的情况下。损害控制手术是治疗危重和不稳定患者的一种选择。复杂性膈疝是一种罕见的危及生命的疾病。胸部和腹部CT扫描是诊断膈疝的金标准。腹腔镜修复术是稳定的复杂性膈疝患者的最佳治疗选择。对于大多数不稳定的患者来说，开放式修复被认为是必要的，对于这些患者，损伤控制手术可以挽救生命。