Effectiveness of laparoscopy in management of patients with penetrating and blunt abdominal trauma.

Objectives: To study the role of laparoscopy in reducing the incidence of non-therapeutic Laparotomies in abdominal trauma, and management of penetrating (PAT) and blunt (BAT) abdominal trauma. Study Design: Prospective Experimental study. Setting: Department of Surgery DHQ Hospital Rawalpindi. Period: January 2018 to June 2018. Material & Methods: All Patients (n=50) were admitted through emergency and were allocated to one of two groups Laparoscopy or Laparotomy group (25 in each) by lottery method according to the inclusion criteria of haemodynamically stable patients with systolic BP>90 mm of Hg. Patients in the Laparotomy group were managed according to the conventional protocol and decision of laparotomy was based on clinical examination, imaging and laboratory investigations. Where as in Laparoscopy group after clinical examination and chemical labortary. Reports diagnostic laparoscopy (screening tool) was done to identify injuries and decide whether patient needs laparotomy or not. Forward viewing 0 degree 10 mm laparoscope was used in all the cases following standard protocols for laparoscopy. Data analysis was done by SPSS 20. P-Value was set at 0.05. Results: Out of total 50 selected haemodynamically stable abdominal trauma patients (n=50) there were 77% males and 23% females. Average age of the patients was 37 years. Overall out of total of 50 patients 30 (60%) patients presented with PAT and 20 (40%) patients presented with BAT. Diagnostic laparoscopy was able to identify abdominal injuries in 96% (24 out of 25) patients. There were no missed injuries in both groups. Similarly there were no non-therapeutic laparotomies in Laparoscopy group where as in Laparotomy group 6 (24%) non-therapeutic laparotomies were done. Conclusion: Laparoscopy reduces the incidence of non-therapeutic laparotomies and missed injuries. It correctly identifies the injuries depending upon the experience of surgeon in selected stable trauma patients.

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Role of Diagnostic Laparoscopy in Penetrating Abdominal Trauma

10.53350/pjmhs2115103514 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3514-3516

Author(s):

Fatima Abbasi ◽

Muhammad Khurram Zia ◽

Farhan Siddique ◽

Ali Adnan ◽

Hina Tahseen

Keyword(s):

Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

Bowel Perforation ◽

Penetrating Trauma ◽

Trauma Patients ◽

Penetrating Abdominal Trauma ◽

Missed Injury ◽

Operative Findings ◽

Intraabdominal Injury

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma

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A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

10.36106/8518548 ◽

2021 ◽

pp. 20-21

Author(s):

Ankur Akela ◽

Ravikant Ravikant ◽

Runni Kumari

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

Penetrating Trauma ◽

Therapeutic Interventions ◽

Trauma Patients ◽

Therapeutic Laparoscopy ◽

Laparoscopic Intervention ◽

Comprehensive Study

Explorative laparotomy has been the mainstay of management in patients with blunt abdominal trauma . The advantage of laparoscopy is that it can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients. Methods: 30 patients of blunt trauma abdomen were retrospectively studied for whom laparoscopic intervention was done. Results: In our study 30 patients with abdominal trauma were included of which 22 (76%) had penetrating trauma and 8 had blunt trauma (24%). Among penetrating trauma, seven patients (31.8%) underwent therapeutic laparoscopy whereas diagnostic laparoscopy was done for 10 patients (45.5%). Conclusions: Laparoscopy can be safely performed in haemodynamically stable patients of abdominal trauma for both diagnostic and therapeutic purposes and can help in avoiding the negative laparotomies.

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Role of MicroRNAs (224 and 96) as Novel Biomarkers for Hepatocellular Carcinoma

Current Cancer Therapy Reviews ◽

10.2174/1573394716999201103225735 ◽

2020 ◽

Vol 16 ◽

Author(s):

Amal A. Mohamed ◽

Mokhtar M. El-Zawahry ◽

Omnia I. Tantawi ◽

Amyan Aalkhalegy ◽

Lamiaa Abdelfattah Fathalla ◽

...

Keyword(s):

Liver Cirrhosis ◽

Statistical Significance ◽

Control Group ◽

P Value ◽

Significance Level ◽

Real Time Quantitative Pcr ◽

Novel Biomarkers ◽

Laboratory Investigations ◽

And Control

Background:: In the early stages of HCC, it is unsatisfactory to depend on alpha-fetoprotein for diagnosis. Objective:: The current study evaluated the possibility of the two miRNAs which are miRNA-96 and miRNA-224 to act as biomarkers for HCC diagnosis. Methods:: This study included 50 patients with HCV-induced HCC and 50 patients with HCV-induced liver cirrhosis for comparison as well as 67 healthy volunteers as controls. All participants were subjected to history taking, clinical examination, and laboratory investigations as well as quantification of serum miRNA-96 and miRNA-224 by real-time quantitative PCR. Results:: MicroRNA 224 level was significantly higher in HCC than the other two groups and was significantly higher in liver cirrhosis than the control group. MicroRNA 96 level was higher in HCC than the control group and was higher in cirrhotic group than both HCC and control groups. However, it doesn’t reach the statistical significance level. The best cut-off value of microRNA 96 for detecting HCC was 3.414 with a sensitivity of 67% and a specificity of 67%, (p-value <0.001). The best cut-off value of microRNA 224 for detecting HCC was 16.75 with a sensitivity of 88% and a specificity of 85% (p-value<0.001). Conclusion:: miRNA-224 could serve as a biomarker for the HCC diagnosis.

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Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

Journal of Surgical Sciences ◽

10.3329/jss.v22i1.44024 ◽

2020 ◽

Vol 22 (1) ◽

pp. 47-51

Author(s):

Debashish Bar ◽

Masrur Akbar Khan ◽

Sanjana Sharmin Shashi ◽

AZM Mahfuzur Rahman ◽

ABM Khurshid Alam ◽

...

Keyword(s):

Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

Exploratory Laparotomy ◽

Operative Management ◽

Bowel Injury ◽

Trauma Patients ◽

Abdominal Injuries ◽

College Hospital ◽

Negative Laparotomy ◽

Intraabdominal Injuries

Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

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Role Of Laparoscopy In Blunt Abdominal Trauma: A Comparative Prospective Cohort Study Between Laparoscopy And Laparotomy In Patients With Blunt Abdominal Trauma

QJM ◽

10.1093/qjmed/hcab097.046 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Tarek Ismail Ouf ◽

Mohamed ElSayed ElShinawi ◽

Ahmed Adel Abbas ◽

Mostafa El Sayed Nagy

Keyword(s):

Cohort Study ◽

Respiratory Tract ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Respiratory Tract Infections ◽

Operative Time ◽

Trauma Patients ◽

Exclusion Criteria ◽

Tract Infections

Abstract Background Trauma is considered to be the main leading cause of death in young adults under 35 years old. Blunt mechanisms accounts for about 95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. This study aims to assess the efficacy of Laparoscopy in management of patients with Blunt abdominal trauma in order to avoid unnecessary laparotomies. Objective To investigate the effectiveness and role of laparoscopy in the management of blunt abdominal trauma patients. Patients and Methods Observational prospective cohort study. Ain Shams University Surgery Hospital. All isolated blunt abdominal trauma patients at Ain Shams University Surgery hospital from 1/3/2019 to 1/9/2019. Eligibility and exclusion criteria applied as following: Eligibility criteria All patients with blunt abdominal trauma presented to ASUH. Patients with class I &class II according to ATLS guidelines for hemorrhagic shock in trauma patients. Patients aged 18 years old or above. Exclusion criteria: Patients with class III &class IV according to ATLS guidelines for hemorrhagic shock in trauma patients. Pregnant patients. Patients with old trauma presented after 24 hours. Patients discharged on demand. Results Laparoscopy decreased the operative time in comparison with laparotomy, the mean operative time for patients underwent laparoscopy is 123.28 minutes while in patients underwent laparotomy is 150.48. Also, time to pass gas post operative after laparoscopy is 1-3 days compared to 2-4 days after laparotomy which is in favor of laparoscopy which is associated with rapid recovery of patients. Laparoscopy is associated with decreased post operative ICU stay (1-3) days in comparison with Laparotomy (2-5) days and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, 2 patients with respiratory tract infections after laparoscopy and no mortality while six patients with respiratory tract infections, 6 patients with wound infection, one patient with deep venous thrombosis and 2 patients died after laparotomy. Conclusion Laparoscopy is found to be a good alternative to laparoscopy, as it is considered to be reliable and safe as a diagnostic and treatment method in hemodynamically stable patients with blunt abdominal trauma, it can be used to reduce the laparotomy rate, and it is associated with lower morbidity and mortality.

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THE ROLE OF ABDOMINAL UITNASONOGRAPHY IN ABDOMINAL TRAUMA PATIENTS

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-198707000-00043 ◽

1987 ◽

Vol 27 (7) ◽

pp. 820 ◽

Cited By ~ 2

Author(s):

YUKIO ENDOH ◽

KUNIO KOBAYASHI ◽

TAKESHI KASAI ◽

HIROMASA SUZUKI

Keyword(s):

Abdominal Trauma ◽

Trauma Patients

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Role of diagnostic laparoscopy in chronic abdominal pain

International Surgery Journal ◽

10.18203/2349-2902.isj20201035 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1077

Author(s):

Anuradha Dnyanmote ◽

Neha Srivastava ◽

Debabrata Gope

Keyword(s):

Abdominal Pain ◽

Diagnostic Laparoscopy ◽

Chronic Abdominal Pain ◽

Research Centre ◽

Common Finding ◽

Categorical Variables ◽

P Value ◽

Chi Square ◽

College Hospital

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work-ups, their pain remains a challenge to all known diagnostic and treatment methods.Methods: To evaluate role of diagnostic laparoscopy in chronic abdominal pain a prospective observational study was done. The present study was conducted on patients with undiagnosed chronic abdominal pain coming to the Department of Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. 75 patients with chronic abdominal pain who attend the General Surgery Department (OPD) were included in the study. Patients were included in the study after taking their voluntary informed consent. The categorical variables were assessed using Pearson chi-square. The quantitative variables were assessed using T-test. The test was considered significant only if the p value comes out to be less than 0.05.Results: Based on the findings of the study after performing diagnostic laparoscopy for 75 patients with chronic abdominal pain it was found that most common finding was of appendicitis (32%) followed by abdominal Koch’s (24%) and post-operative pain relief using VAS showed p value of less than 0.05 at 3 months of follow up post diagnostic laparoscopy.Conclusions: The present study concluded that laparoscopy is an effective diagnostic role in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause. The advantage of diagnostic laparoscopy over non-invasive methods is the ability to perform therapeutic procedure at the same time in cases of chronic abdominal pain. Diagnostic laparoscopy is safe, cosmetically better and having less morbidity.

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Clinical and laboratory differences and role of gene xpert in tuberculous pleural effusion

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v10i1.37082 ◽

2021 ◽

Vol 10 (1) ◽

pp. 4-7

Author(s):

Manoj Kumar Shah ◽

Sushil Baral ◽

Tulsi Bhattarai

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Mean Value ◽

P Value ◽

Common Symptom ◽

Cross Sectional ◽

Fluid Analysis ◽

Laboratory Investigations ◽

The Difference

Background: The diagnosis of pleural effusion and its cause are essential for pleural fluid analysis. We have evaluated clinical and laboratory differences among the tubercular pleural effusion. Methods: The cross-sectional, observational hospital based study was conducted in Bir hospital, Nepal. All patients were evaluated by clinically and laboratory investigations. Patients enrolled for study have pleural effusion and pleural fluid analysis indicative of an exudative pleural effusion using lights criteria. The criteria of enrollment of the patients were pleural fluid for Adenosine deaminizes value more than 40 IU/L, positive for gene xpert test and pleural effusion of any cases with sputum positive pulmonary tuberculosis. Patients were divided into two groups lymphocytic and neutrophilic predominant pleural effusion. Results: Among 100 patients with diagnosis of exudative tubercular pleural effusion, the most common symptom was pleuritic chest pain in 85%, followed by fever in 84% and cough in 82%. Among the tubercular pleural effusion, 21% had neutrophils predominant and 79% had Lymphocytes predominant. The patients with neutrophil predominant Tubercular pleural effusion had higher fever rates (90.5vs.82.5%) than those with lymphocyte-predominant Tubercular pleural effusion. The mean value of Neutrophil predominant pleural fluid for lactate dehydrogenase (LDH) level was 1657.5 IU/L and protein was 5.3gm/dl and in lymphocyte predominant pleural fluid for LDH value was 610.2 IU/L and protein was 4.6 gm/dl; the difference was statistically significant with P value of <0.001. Only 15% of patients had sputum positive for Acid fast bacilli. Among the sputum positive patients, 47% had positive for pleural fluid for gene xpert test with all patients had rifampicin sensitive. The sensitivity of pleural fluid for gene xpert test was 46.6%, and specificity was 90%. Conclusion: In pleural effusion, the positivity of gene xpert for pleural fluid was higher among the sputum positive patients. The prevalence of Neutrophil-predominant pleural effusion was common in tubercular pleural effusion.

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