Laparoscopy in Penetrating Abdominal Trauma

Uranues, Selman; Popa, Dana Elena; Diaconescu, Bogdan; Schrittwieser, Rudolph

doi:10.1007/s00268-014-2904-5

Cited by 53 publications

(30 citation statements)

References 49 publications

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“…Laparoscopy is a diagnostic but also therapeutic minimally invasive tool, efficient and safe in selected patients when it is performed by surgeons with laparoscopy and emergency surgery experience in trauma centres (1,2). Laparoscopy is accepted and recommended in selected cases of abdominal and thoracoabdominal stab wounds for diagnosis of diaphragmatic injuries (2,3,4). The actual benefit of DL in abdominal trauma is still under review.…”

Section: Introductionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

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Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.

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Section: Introductionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

View full text Add to dashboard Cite

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“…Overall, it can avoid non-therapeutic exploratory laparotomy in up to 70% of patients and, in selected cases, it can also have a therapeutic role in repairing minor lesions. 22 , 23 Also in blunt abdominal trauma, laparoscopy could represent a similar diagnostic option, especially in patients with equivocal clinical and radiologic findings, before doing a laparotomy. However, its role remains undefined because the number of treated patients is small and only few series with promising results have been reported.…”

Section: Discussionmentioning

confidence: 99%

Hollow viscus injuries: predictors of outcome and role of diagnostic delay

Mingoli¹,

Torre²,

Brachini³

et al. 2017

TCRM

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IntroductionHollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.MethodsFrom our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.ResultsOverall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.ConclusionThere is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.

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“…In this regard, laparoscopy is emerging as a minimally invasive tool in the management of penetrating abdominal trauma, with a sensitivity, specificity and accuracy approaching 100%. [7][8][9] Its merits may include avoidance of a nontherapeutic laparotomy and a long laparotomy wound with its attended complications. In our patient, the necessity for therapeutic anticoagulation and our desire to decrease the overall severity of trauma to which the patient was subjected, were strong incentives to start the abdominal part of surgery by laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First?

Rabie¹,

Gallo²,

Refaie³

et al. 2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Aim: To report on the clinical course of a patient who received penetrating shrapnel to the heart and colon.Background: Penetrating missiles to the heart is a highly lethal incident, particularly, when associated with other serious injuries.Case report: This is the case of a 29-year-old male soldier, who sustained multiple shrapnel injuries caused by an explosive device in the war zone. Shrapnel penetrated the cecum and another lodged in the interventricular septum of the heart. Surprisingly, the patient was stable enough to undergo a staged procedure, where he was subjected to limited right hemicolectomy first, followed by open heart surgery to extract the cardiac shrapnel twelve hours later. His convalescence was uneventful and was discharged in a good condition. Conclusion:With timely intervention and close collaboration between the concerned clinicians in specialized centers, patients with penetrating shrapnel to vital structures, including the heart, could have a successful outcome.Clinical significance: Critical thinking is needed to prioritize which injuries to deal with first, in patients with near lethal injuries.

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Laparoscopy in Penetrating Abdominal Trauma

Cited by 53 publications

References 49 publications

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Hollow viscus injuries: predictors of outcome and role of diagnostic delay

Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First?

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