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.
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ABSTRACT: Laparoscopy, as a minimally invasive diagnostic and therapeutic tool in blunt abdominal trauma (BAT), is not commonly used and has been shown to be controversial. The aim of this study is to assess the role of laparoscopy in the diagnosis and therapy of BAT. A systematic review and a comprehensive literature search was performed at the U.S. National Library of Medicine site in Medline and PubMed from January 2000 to 31 December 2007. This article attempts to outline the efficacy, the indications, contraindications, surgical technique and therapeutic possibilities of laparoscopy in BAT. Pediatric surgery articles and those addressing penetrating abdominal wounds, nontraumatic abdominal emergencies and iatrogenic injuries were excluded from this review. Sixty-six articles were reviewed, which included 22 case studies, 27 case reports, 17 reviews and 2 guidelines. The reviewed articles comprised 343 patients with BAT and laparoscopic approach. Therapeutic laparoscopy was possible in 168 cases (48.98%), 51 cases were converted (14.87%), overlooked injuries were absent, 6 patients had complications (1.75%), no mortality laparoscopy-related. The main indications for laparoscopy in BAT include the confirmation of suspected diaphragmatic defects, suspected hollow viscus and mesenteric injuries, in patients with inconclusive clinical exams and abdominal imaging. Diagnostic laparoscopy (DL) is also indicated in patients with suspected intra-abdominal injuries when advanced emergency imaging investigations are unavailable. Laparoscopy allows the surgeon to perform hemostasis, resections, suturing, autotransfusion, etc. Although is not widely used, laparoscopy could still be useful in selected patients with BAT who have equivocal findings on clinical exam a nd imaging investigations in order to clarify the lesional diagnosis, thus avoiding unnecessary laparotomies. Multicenter prospective studies are needed to better assess the role of laparoscopy in blunt abdominal trauma.Chirurgia (Bucharest, Romania: 1990) 01/2011; 106(1):59-66. · 0.78 Impact Factor
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ABSTRACT: The high missed occult small bowel injuries (SBI) associated with laparoscopy in trauma (LIT) is a major reason why some surgeons still preclude LIT today. No standardized laparoscopic examination for evaluation of the peritoneal cavity is described for trauma. The objective of this article is to verify if a systematic standardized laparoscopic approach could correctly identify SBI in the peritoneal cavity for penetrating abdominal trauma (PAT). Victims with PAT were evaluated in a prospective, nonrandomized study. A total of 75 hemodynamically stable patients with suspected abdominal injuries were operated by LIT and converted to laparotomy if criteria were met: SBI and lesions to blind spot zones--retroperitoneal hematoma, injuries to segments VI or VII of the liver, or injuries to the posterior area of the spleen. Inclusion criteria were equivocal evidence of abdominal injuries or peritoneal penetration; systolic blood pressure >90 mm Hg and <3 L of IV fluids in the first hour of admission; Glasgow Coma Scale score >12; and age >12 years. Exclusion criteria were back injuries; pregnancy; previous laparotomy; and chronic cardiorespiratory disease. Sixty patients were males and there were 38 stab wounds and 37 gunshot wounds. No SBI was missed, but a pancreatic lesion was undiagnosed due to a retroperitoneal hematoma. Twenty patients (26.6%) were converted. Unnecessary laparotomies were avoided in 73.33%. Therapeutic LIT was possible in 22.7%. Accuracy was 98.66% with 97.61% sensitivity and 100% specificity. Standard systematic laparoscopic exploration was 100% effective to detect SBI in the peritoneal cavity. Conversion from LIT to laparotomy should be done if injuries to blind spot zones are found which are poorly evaluated by LIT. Therapeutic LIT is feasible in PAT.The Journal of trauma 09/2009; 67(3):589-95. · 2.35 Impact Factor
- Injury 01/2009; 40(1):7-10. · 1.93 Impact Factor