The role of laparoscopy in blunt abdominal trauma.
ABSTRACT In a collective analysis of 11 reports with a total of 355 blunt abdominal trauma patients, the sensitivity and specificity of diagnostic laparoscopy in predicting the eventual need for therapeutic laparotomy were 94% and 98%, respectively, with an overall accuracy of 97%. Although fairly accurate and safe (morbidity rate about 1.2%), the invasiveness, cost and time-consuming nature of diagnostic laparoscopy limit its routine use in trauma patients. It could, however, be useful in selecting patients with minor or nonbleeding injuries for nonoperative management after positive peritoneal lavage or computed tomography, and in excluding occult bowel and diaphragmatic injuries in patients with equivocal findings, thereby reducing the number of unnecessary laparotomies. With the improvement of laparoscopic techniques and instrumentation, more injuries can probably be managed laparoscopically with all the benefits observed with the shift from open to laparoscopic procedures in other patient populations, and it is likely that laparoscopy will find its place as an integral part of evaluating and treating patients with blunt abdominal trauma. At present, however, laparoscopy cannot be recommended as a routine tool for evaluating patients with blunt abdominal trauma, except in controlled clinical trials.
- Zentralblatt für Chirurgie 01/2002; 127(6):533-537. · 1.19 Impact Factor
Article: Plaies et contusions de l’abdomen[Show abstract] [Hide abstract]
ABSTRACT: Diagnosis of visceral organ injuries is usually difficult in blunt and penetrating abdominal trauma because clinical examination is poor. Improvements in imaging led to the development of a non operative management to avoid unnecessary surgery. Indication for an emergent laparotomy is limited to unstable patients with hemoperitoneum. This approach should not be considered unless the hospital offers a well-trained trauma team including surgeons, anesthesiologists, gastroenterologists, and radiologists, and the patient meets the following criteria : hemodynamic stability without associated injuries requiring a potentially hemorrhagic surgery. One of the consequences of this approach is the risk of a missed bowel injury with a poor prognosis if surgery is delayed. When surgical exploration is needed, laparoscopy cannot be recommended as a routine tool to assess patients with abdominal trauma. The aim of surgery is to be conservative, when possible. If these rules are followed, appropriate timing and management will be offered to these very serious patients.EMC - Chirurgie 01/2004; 1(1):18-31.
- Injury Extra 12/2009; 40(12):277-278.