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

Abstract

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.

Potential Spectrum of Accompanied Penetrating Abdominal Intraperitoneal Injuries with Bowel Evisceration: Surprises Awaiting the Trauma Surgeon in Resource Limited Settings

“…Case Reports in Surgery triple contrast CT scan [4]. This is not always available in all resource The standard management protocol for penetrating inal trauma is laparotomy [5,15]. However, management of patients poses a dilemma for attending trauma surgeons weighing the risk of missing life threating injuries when non/ minimal invasive diagnostic and therapeutic procedures are opted versus the standard traditional open laparotomy method [16].…”

“…There is controversy on the roles of diagnostic laparoscopy in management of penetrating abdominal injuries [ 20 ] with no consensus on its role [ 15 ] The high rate of missed injuries and development of tension-pneumothorax pose a serious risk in trauma patients [ 16 ]. Patients with haemodynamic instability, intracranial trauma, bowel evisceration, and overt peritonitis are contraindicated for laparoscopy [ 16 ].…”

“…Laparoscopic settings require trained staff and equipments [ 16 ]. Decision on laparoscopy is dependent on surgeons' experience and availability of equipment [ 15 ].…”

Laparoscopic treatment for colonic injuries following penetrating trauma: A feasible option in a surgical department of Sub-Saharan Africa

“…Laparoscopy is superior to laparotomy in terms of reduction of postoperative pain, length of hospital stay, surgical site infections and peritoneal adhesions [4] , [5] . A study comparing the two approaches for the treatment of hollow viscus injuries in abdominal trauma, on nearly 4000 patients, concluded that laparoscopy was superior in terms of postoperative complications [6] .…”

Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature)

“…Wang considered that laparoscopic surgery can be a practical alternative to laparotomy for appropriate patients. Decisions to perform laparoscopy should be based on the experiences of the surgeon and the resources available [ 23 ]. Kones et al [ 4 ] identified two indications for the choice of laparotomy for thoracoabdominal injuries – hemodynamic instability and peritonitis.…”