Laparoscopy for blunt abdominal trauma: a challenging endeavor

Abstract

Background and Aims: Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. Material and Methods: Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. Results: A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4–38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. Conclusion: Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.

Laparoscopic splenectomy after trauma

“…Laparoscopy for penetrating trauma is performed only in the centre with high rate of penetrating injuries and advanced experienced surgeon in these fields. [ 50 51 52 ] In these setting as shown by Sosa et al .,[ 53 ] laparoscopy can be 100% accurate in identifying peritoneal stab wounds According to series article review, the attitude is to attempt at first a NOM with or without splenic embolisation and in case of failure of this proceed with LS. [ 17 21 22 23 24 25 ] In this retrospective data set, we were unable to elucidate the clinical factors prompting the decision to perform surgery; however, prior reports showed that factors which lead to failure of NOM include age older than 55 years, ISS >25, haemoperitoneum >300 mL, rupture of subcapsular haematoma or intraparenchymal pseudoaneurysms active contrast extravasation on computed tomography and delayed bleeding.…”

The Efficacy and Safety of Laparoscopy for Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis

“…However, recent studies are more in the realm of therapeutic laparoscopy, contributing to decreasing conversion rate. They included laparoscopic procedures such as bowel resection, bowel repair, bladder repair, splenectomy, distal pancreatectomy, diaphragm repair, and hemostasis [15,16,18,20,21,23]. In early studies, laparotomy was needed for these procedures.…”

“…Data from all eligible studies were extracted by two investigators. Data extracted from each eligible study include the following [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]: name of the first author, year of publication, study location, study design, study period, number of patients analyzed, age of patients, injury severity score (ISS), operation time, volume of intraoperative blood loss, rate of conversion to open laparotomy, missed injury, nontherapeutic laparotomy, duration of hospital stay, overall complications, rate of wound infection, and mortality rate. Conversion to open laparotomy was defined as laparotomy after initial laparoscopy during the same operation.…”

“…In terms of study design and anatomic location of trauma, there was substantial heterogeneity across the studies (Table 1). Fabian [6] 1993 Townsend [7] 1993 Taner [8] 2001 Mathonnet [9] 2003 Omori [10] 2003 Mitsuhide [11] 2005 Huscher [12] 2006 Kaban [13] 2008 Mallat [14] 2008 Shah [15] 2011 Johnson [16] 2013 Memon [18] 2013 Khubutiya [17] 2013 Huang [19] 2017 Koto [23] 2018 Parajuli [22] 2017 Lin [20] 2018 Matsevych [21] 2018 Nicolau [24] 2019 NOS, Newcastle-Ottawa scale; NRS, non-randomized study; , The study has met the criteria for a domain of the Newcastle-Ottawa Scale.…”

Role of diagnostic laparoscopy in blunt abdominal trauma

“…Our findings correlates with the laparoscopic findings in the study done by muhammed rafique memom et al [6] . M. Z. Koto et al [7] conducted a study on 35 stable patients who underwent laparoscopy. Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients.…”