Abstract
BackgroundThere is still no consensus regarding the role of laparoscopy in trauma cases. The purpose of this paper is to assess the value of diagnostic and therapeutic laparoscopy for patients with blunt or penetrating abdominal trauma by performing a systematic review and meta-analysis.MethodsPubMed, Embase, and the Cochrane library were systemically searched for the randomized controlled trials (RCTs) and non-RCT comparative studies on effectiveness and safety of laparoscopy vs. laparotomy for the two authors independently performed the search, data extraction, and quality assessment.ResultsA total of 5,517 patients were enrolled in 23 eligible studies that were published in English. Meta-analysis results suggest that there is no significant difference in the incidence of missed injury and mortality between abdominal trauma patients receiving laparoscopy and those receiving laparotomy. Concerning postoperative complications, compared with patients in the open surgery group, those in the laparoscopy group are at a similar risk of intra-abdominal abscesses, thromboembolism, and ileus, while there is a decreased incidence of wound infection and pneumonia. Besides, patients in the laparoscopy group experience shorter hospitalization times and procedure times. For most outcomes, the sensitivity analysis yielded similar results to the primary analysis.ConclusionLaparoscopic surgery is a practical alternative to laparotomy for appropriate patients. The decision to perform laparoscopy should be based on the experience of the surgeon and the resources available.
Highlights
The Medical Subject Headings (MeSH) including “laparoscopy,” “abdominal injuries,” as well as free text words like “laparoscop∗,” “minimal∗ invasive,” “abdom∗,” “injur∗,” “wound∗,” “stab∗,” “shot∗,” “shoot∗,” “lacerat∗,” “trauma∗,” “penetrat∗,” and “blunt∗,” in combination with the Boolean operators “AND” and “OR.” Besides, we searched the references listed in all the articles that were initially selected
Comparative studies that were published in English, and focused on the comparison of laparoscopy and laparotomy for the management of abdominal trauma were included
A total of 5,517 individual patients were involved in the study, with 2,594 patients enrolling in the laparoscopy group, and 2,923 patients in the laparotomy group
Summary
Trauma is the fourth leading cause of death in the overall population, while it is the main cause of death during the first half of the human life span (1). Advances of imaging technology and selective nonoperative management have led to a decrease in non-therapeutic laparotomy for haemodynamically stable patients (9–11). The feasibility and benefits of diagnostic and therapeutic laparoscopy in selected haemodynamically stable trauma patients have already been demonstrated, a widely accepted consensus has not yet been reached (8, 13). Soon after the laparoscopy procedure was introduced, several systematic reviews (14–16) summarizing its value for penetrating or blunt abdominal trauma were published. We integrated newly published studies with previous evidence to comprehensively compare the effectiveness and safety of laparoscopy with laparotomy on penetrating or blunt abdominal trauma. The purpose of this paper is to assess the value of diagnostic and therapeutic laparoscopy for patients with blunt or penetrating abdominal trauma by performing a systematic review and meta-analysis
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