A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

Mapping Intimacies ◽

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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The role of laparoscopy in patients with abdominal trauma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191690 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1853

Author(s):

Pranav K. Sharma ◽

Gaurav Gupta

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Case Reports ◽

Operating Time ◽

Penetrating Trauma ◽

Exploratory Laparotomy ◽

Therapeutic Interventions ◽

Trauma Patients ◽

Diagnostic Dilemma ◽

Therapeutic Laparoscopy

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal 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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Effectiveness of laparoscopy in management of patients with penetrating and blunt abdominal trauma.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.08.4737 ◽

2021 ◽

Vol 28 (08) ◽

pp. 1090-1095

Author(s):

Sajid Rashid ◽

Keyword(s):

Clinical Examination ◽

Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

P Value ◽

Trauma Patients ◽

Laparoscopy Group ◽

Missed Injuries ◽

Laparotomy Group ◽

Laboratory Investigations

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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Laparoscopy for blunt abdominal trauma: a challenging endeavor

Scandinavian Journal of Surgery ◽

10.1177/1457496918816927 ◽

2018 ◽

Vol 108 (4) ◽

pp. 273-279 ◽

Cited By ~ 2

Author(s):

M. Z. Koto ◽

O. Y. Matsevych ◽

F. Mosai ◽

S. Patel ◽

C. Aldous ◽

...

Keyword(s):

Hospital Stay ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Injury Severity ◽

Length Of Hospital Stay ◽

Trauma Patients ◽

Therapeutic Laparoscopy ◽

The Mean ◽

Trauma Score

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.

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Trauma to the Abdomen and Pelvis

10.2310/tywc.4353 ◽

2018 ◽

Author(s):

Zahir Basrai ◽

Timothy Jang ◽

Manuel Celedon

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Peritoneal Lavage ◽

Penetrating Trauma ◽

Balloon Occlusion ◽

Organ Injury ◽

Abdominal Organs ◽

Fast Exam ◽

Definitive Management ◽

Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs. This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

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Spontaneous Pnemoperitoneum after Blunt Trauma Chest –Diagnostic Dilemma-Role of Diagnostic Laparoscopy – Case Report

Journal of Trauma & Treatment ◽

10.4172/2167-1222.1000164 ◽

2013 ◽

Vol 02 (02) ◽

Cited By ~ 1

Author(s):

Samir R Nayak

Keyword(s):

Case Report ◽

Blunt Trauma ◽

Diagnostic Laparoscopy ◽

Diagnostic Dilemma ◽

Blunt Trauma Chest

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Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽

10.1177/1460408617703677 ◽

2017 ◽

Vol 20 (1) ◽

pp. 30-37 ◽

Cited By ~ 3

Author(s):

Meike Schuster ◽

Natasha Becker ◽

Amanda Young ◽

Michael J Paglia ◽

A Dhanya Mackeen

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Blunt Injury ◽

Trauma Patients ◽

Severely Injured ◽

Trauma Systems ◽

Severely Injured Patients ◽

Vaginal Deliveries ◽

Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

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The Role of Laparoscopy in Trauma: A Ten-Year Review of Diagnosis and Therapeutics

The American Surgeon ◽

10.1177/000313480807401207 ◽

2008 ◽

Vol 74 (12) ◽

pp. 1166-1170 ◽

Cited By ~ 7

Author(s):

Ali F. Mallat ◽

Matthew L. Mancini ◽

Brian J. Daley ◽

Blaine L. Enderson

Keyword(s):

Minimally Invasive ◽

Trauma Patients ◽

Hemorrhage Control ◽

Invasive Approach ◽

Therapeutic Laparoscopy ◽

Negative Laparotomy ◽

Trauma Population ◽

Diaphragmatic Repair ◽

Student’S T

Minimally invasive surgery has found many applications in general surgery. The role of laparoscopy in trauma has been debated as a diagnostic, as well as therapeutic, tool in hemodynamically stable patients. This study evaluated laparoscopy in the trauma population. A retrospective review of all laparoscopies performed in hemodynamically stable trauma patients from 1996 until 2006 was conducted. Mechanisms of injury, perioperative data, and demographic variables were analyzed using descriptive statistics and Student's t test. Exploratory diagnostic laparoscopy was performed on 102 patients. Laparoscopy was negative for 65 per cent of patients; 12 per cent of these were converted to laparotomy due to adhesions, hemoperitoneum, or surgeon preference. None of the conversions revealed intra-abdominal injury at laparotomy. An injury was diagnosed at laparoscopy in the remaining 35 per cent, with 55 per cent conversion rate to repair the injury. Therapeutic laparoscopy included serosal repair, hemorrhage control, diaphragmatic repair, and other standard laparoscopic treatments. No patient required re-exploration, there were no missed injuries or other complications, and no patient died in this study. Laparoscopy has an important diagnostic and therapeutic role in selected hemodynamically stable trauma patients. Using a minimally invasive approach can reduce the potential morbidity of negative laparotomy.

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