Title: A randomized prospective study comparing non operative management with laparoscopic treatment in patients with a diaphragm injury following left thoracoabdominal stab wounds.

Aim of the Study: The aim of this study is to access the clinical outcome of potential occult diaphragm injuries in a group of patients presenting at the Groote Schuur trauma centre with left sided thoracoabdominal stab wounds, if an expectant non operative management course is taken.

Objects of the Study: To obtain the above mentioned aim the study will undertake;

• to do laparoscopy on a group of randomly selected patients with left thoracoabdominal stab wounds to obtain the incidence of occult diaphragm injury.
• to assess the incidence and clinical outcome of delayed diaphragm visceral herniation in the study group.

Inclusion Criteria:

• Hemodynamically stable patients
• Patients with penetrating stab wounds bounded by
• Superiorly the 4th intercostal space
• Lateral the tip of the left scapula
• Inferior by the left costal margin
• Medially by the sternum
• Signed informed consent

Exclusion Criteria:

• Hemodynamically unstable patients
• Previous penetrating injury to the area mentioned under inclusion criteria
• Patients requiring early surgical exploration for injuries other than diaphragm injuries
• If a diaphragm injury is detected on imaging
• A positive pregnancy test