Diagnostic laparoscopy in penetrating abdominal trauma

Cocco, Annelise; Bhagvan, Savitha; Bouffler, Clare; Hsu, Jeremy

doi:10.1111/ans.15140

Cited by 33 publications

(21 citation statements)

References 15 publications

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“…The mean postoperative hospital stay was 5±3.8 days. [5][6][7][8][9][10][11][12][13] An intraabdominal abscess developed in one patient postoperatively. No patients developed postoperative mortality.…”

Section: Resultsmentioning

confidence: 97%

“…In order to decrease the rate of non-therapeutic laparotomy in patients with penetrating thoracoabdominal trauma, laparoscopy for hemodynamically stable patients has been proposed as an alternative diagnostic, and potentially therapeutic, method. [4,5] In this study, we aimed to present the patients who underwent laparoscopic treatment in our center, with the diagnosis of traumatic diaphragmatic injury, in the last 2 years…”

Section: Introductionmentioning

confidence: 99%

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Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Topal¹

2019

Laparosc Endosc Surg Sci

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Introduction: Diaphragmatic injuries are rare and occur in about 3% of all abdominal injuries. While 5% are caused by motor vehicle accidents, 10%-15% are caused by penetrating trauma. Diaphragmatic injury develops in 0.8%-7% of blunt trauma cases and 10%-15% of penetrating trauma cases. The aim of this study was to present a report of patients from a single center who underwent laparoscopic repair with the diagnosis of traumatic diaphragmatic injury during a 2-year period. Materials and Methods: Patients who underwent laparoscopic surgery at the study center due to traumatic diaphragmatic injury between May 2017 and November 2018 were included in the study. The demographic characteristics of the patients, cause of injury, additional injured organs, anatomical localization of the injury, surgical procedure, quantity of intraoperative hemorrhage, rate of conversion to open surgery, duration of hospitalization, morbidity and mortality rates, and 30-day readmission rate were retrospectively reviewed using hospital files and electronic records. Results: Of the patients enrolled in the study, 3 were female and 1 was male. The mean age was 47.25 years (range: 36-66 years). The injury etiology was penetrating injury for 3 patients and in-vehicle traffic accident for 1 patient. Two patients had a hemopneumothorax, which was treated with a chest tube. One patient displayed hematoma in the liver and spleen. The injury to the left diaphragm was 1-4 cm in diameter in all of the study patients. A primary repair was performed in all cases. The mean quantity of intra-abdominal bleeding was 212 mL (range: 100-300 mL) and the mean postoperative hospital stay was 7.5 days (range: 5-13 days). A postoperative intra-abdominal abscess developed in 1 patient. There was no instance of mortality and no patient was re-admitted in the 30-day period after discharge. Conclusion: It has been reported in the literature that laparoscopic approaches can be used safely in selected cases of abdominal injury, and can potentially have the benefits of laparoscopy. The results of this study also suggest that laparoscopy can be used safely in cases of traumatic diaphragmatic injury in the appropriate patients.

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Topal¹

2019

Laparosc Endosc Surg Sci

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“…This is probably because the ability to conduct laparoscopy depends on hospital resources and the surgical skills of the surgeon ( 20 ). Another factor that may influence the results is that, different hospitals adopt various policies, and some centers recommend routine open surgery while others conduct laparoscopy in comparable patients ( 4 , 7 , 42 , 43 ). Additionally, we noted that conversion rates are lower now than they were a decade ago, perhaps due to technological improvements in laparoscopic instruments and the accumulation of procedural experience.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis

Wang¹,

Cheng²,

Liu³

et al. 2022

Front. Surg.

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BackgroundThere is still no consensus regarding the role of laparoscopy in trauma cases. The purpose of this paper is to assess the value of diagnostic and therapeutic laparoscopy for patients with blunt or penetrating abdominal trauma by performing a systematic review and meta-analysis.MethodsPubMed, Embase, and the Cochrane library were systemically searched for the randomized controlled trials (RCTs) and non-RCT comparative studies on effectiveness and safety of laparoscopy vs. laparotomy for the two authors independently performed the search, data extraction, and quality assessment.ResultsA total of 5,517 patients were enrolled in 23 eligible studies that were published in English. Meta-analysis results suggest that there is no significant difference in the incidence of missed injury and mortality between abdominal trauma patients receiving laparoscopy and those receiving laparotomy. Concerning postoperative complications, compared with patients in the open surgery group, those in the laparoscopy group are at a similar risk of intra-abdominal abscesses, thromboembolism, and ileus, while there is a decreased incidence of wound infection and pneumonia. Besides, patients in the laparoscopy group experience shorter hospitalization times and procedure times. For most outcomes, the sensitivity analysis yielded similar results to the primary analysis.ConclusionLaparoscopic surgery is a practical alternative to laparotomy for appropriate patients. The decision to perform laparoscopy should be based on the experience of the surgeon and the resources available.

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“…Progression to laparotomy would then be both injury severity and surgeon dependent, as the operation may be completed successfully via laparoscopy. A recent Australian review highlighted that peritoneal breach alone as an indicator for laparotomy is associated with a moderate incidence of non-therapeutic laparotomy [10]. Our approach intends to reduce the rate of non-therapeutic laparotomy, which increases patient morbidity in both the short- and long-term through postoperative pain, ileus, wound infection, bowel injury, small bowel obstruction and hernia risk.…”

Section: Discussionmentioning

confidence: 99%

Suprapubic penetrating abdominal trauma - defining peritoneal breach and choices in operative intervention

Papanikolas

Sarkar

Kandiah

et al. 2019

Journal of Surgical Case Reports

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Penetrating abdominal trauma is an uncommon cause of presentation to emergency departments in Australia and is frequently associated with the clinical need for emergent operative intervention. Advances in imaging modalities, improved laparoscopic techniques and structured approaches to resuscitation in trauma have now allowed potential minimally invasive management of such injuries, avoiding laparotomy and therefore defining peritoneal breach; the major determinant of intra-abdominal organ injury in this setting is critical. We present the case of a self-inflicted stab injury to the suprapubic region in an otherwise healthy man and describe the combination of imaging and operative modalities used to define peritoneal breach in this case which successfully reduced the patient’s morbidity by avoiding non-therapeutic laparotomy.

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Diagnostic laparoscopy in penetrating abdominal trauma

Cited by 33 publications

References 15 publications

Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries

Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis

Suprapubic penetrating abdominal trauma - defining peritoneal breach and choices in operative intervention

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