Emergency Laparoscopy for Abdominal Trauma

Abstract

Trauma patients are particularly frail since most of them have multiple organ injuries. Several advantages of the minimally invasive approach such as decreased postoperative pain and less adhesion formation, faster recovery and shorter length of hospital stay, earlier return to work and daily physical activities, fewer postoperative wound infections, incisional hernias, and better cosmetic results are already well known and are easily reproducible also in the setting of trauma patients. Moreover, in the injured patients the use of minimally invasive surgery is particularly valuable since it is able to decrease the systemic inflammatory response with lower risk of secondary organ injury (especially lungs and kidneys). Diagnostic laparoscopy seems to significantly reduce the rate of negative laparotomies, having high sensitivity, specificity, and accuracy, especially in penetrating abdominal trauma, with better cost-effectiveness when compared to open surgery. Despite these potential benefits, laparoscopy has not yet gained widespread acceptance within the trauma surgical community. Provided a careful selection of patients and advanced laparoscopic surgical training, this technique can be then extremely useful in trauma patients as both a diagnostic and, eventually, therapeutic tool. In conclusion, the current evidence shows that laparoscopy in selected hemodynamically stable trauma patients can significantly decrease nontherapeutic laparotomy rates, length of stay, and hospital costs and is highly sensitive and specific with very low missed injury rates, but adherence to a standardized laparoscopic examination technique and operator experience with routine use of laparoscopy in elective or acute care practice strongly influence positive results of minimally invasive surgery in trauma.