Avoiding of Nontherapeutic Laparotomies in Blunt Abdominal Trauma with Aid of Laparoscopy

Abstract

Introduction: As there is particular danger that an injury to the diaphragm or intestines be overlooked. The decision in favor of surgery or nonoperative conservative treatment in abdominal trauma requires a precise diagnosis that is not always possible with imaging techniques. Owing to this circumstance, the indications for exploratory laparotomy should be generous with laparoscopy up to 41% of exploratory nontherapeutic laparotomies could be, or could have been, avoided. Methods: Only in stable blunt abdominal trauma patients. A diagnostic laparoscopy with therapeutic option should only be attempted. three trocars are used and the exploration of the abdomen is systematic, beginning with the right upper quadrant and continuing clockwise injuries to the diaphragm. Small lacerations of the intestines and mesentery can be detected and sutured endoscopically parenchymal organs Injuries can be sealed with tissue adhesive and collagen tamponade to prevent further bleeding. Results: The number of unnecessary laparotomies and the related morbidity can be reduced with routine use of laparoscopy, because it sensitivity reached 90-100% in abdominal trauma. Conclusions: In stable blunt trauma patient minimally invasive surgery has become established as a useful tool. The future holds exciting scope for this field of surgery through innovative development in computer technology and robotic systems. The advantages are reduction of morbidity, shortening of hospitalization and cost-effectiveness. Aims and objectives: The aim of this review is to show the benefits and risks of laparoscopy in blunt trauma patients. The benefits: The main benefits of laparoscopy are that it can reduce the rate of nontherapeutic and negative laparotomies,identify diaphragmatic injuries accurately, and in some cases provide a therapeutic option. It should be emphasized that the use of laparoscopy as a diagnostic ortherapeutic method in patients with trauma is reserved only for hemodynamically stable patients. It should be kept in mind that laparoscopy has limitations in the diagnosis of hollow visceral injury. Laparoscopy can detect and repair diaphragmatic injuries and exclude the risk of nontherapeutic laparotomy due to a nonbleeding injury of the spleen or liver. Further advantages are reduced morbidity, shortened hospital stay, and lower cost. The risks: (1) Overlooking of injuries, mainly involving the intestinal tract and so delaying their treatment, leading in turn to considerably increased morbidity; (2) Laparoscopy-specific complications, such as vascular and intestinal injuries; (3) Gas embolism. Missed injuries are the most common of these three problems and probably pose the most serious risk, though the literature data are very unclear on this. While some authors find that laparoscopy is inadequate for detecting intestinal injuries.3,4 Even a very experienced surgeon should not hesitate to convert to open technique if there is any uncertainty.9 Minimally invasive surgery has become established as a useful tool in the management of trauma. The future holds exciting scope for this field of surgery through innovative developments in computer technology and robotic systems. Material and methods: A literatures search was performed using Medline and the Search engine google, Springerlink and Highwire press. The following search terms were used: Laparoscopy, blunt trauma, diagnosis of abdominal trauma. Hundreds of literatures and papers published discussing this subject. The most recent selected. The selected papers were screened for farther references. Criteria for selection were the number of cases (excluded if less than 20), methods of analysis, operative procedure (universally accepted procedures were selected), and the institution where the study done.