Is laparoscopy still of value in managing the patient with abdominal trauma?

Abstract

Introduction Stabbings are an increasing international problem and the UK is not exempt. Although the incidence and costs of negative laparotomy are well known, and laparoscopy has been available for over 100 years, it is only in the last three decades that has seen its effective utilization in trauma both as a diagnostic and therapeutic modality. Methods A retrospective two-year study of all patients undergoing laparoscopy for suspicion of diaphragmatic injury or breach of the peritoneum who were haemodynamically stable from non-ballistic penetrating torso trauma at St Mary’s Hospital (Imperial Healthcare Trust). Results Three groups of patients were identified: diagnostic laparoscopy without injury (n = 31), laparoscopy with injury ± laparoscopic treatment (n = 41) and diagnostic laparoscopy converted to laparotomy (n = 10). The patients who had laparoscopic intervention had a shorter hospital stay (2 vs. 5 days, p = 0.004), decreased intensive treatment unit admission (p = 0.007) and decreased intensive treatment unit stay (p = 0.007) compared to those who had conversion to laparotomy. Conclusion Trauma laparoscopy is a useful modality in managing selected trauma patient with suspected intra-abdominal injuries and can avoid unnecessary laparotomy. It is associated with a shorter hospital stay.