Role Of Laparoscopy In Blunt Abdominal Trauma: A Comparative Prospective Cohort Study Between Laparoscopy And Laparotomy In Patients With Blunt Abdominal Trauma

Abstract

Abstract Background Trauma is considered to be the main leading cause of death in young adults under 35 years old. Blunt mechanisms accounts for about 95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. This study aims to assess the efficacy of Laparoscopy in management of patients with Blunt abdominal trauma in order to avoid unnecessary laparotomies. Objective To investigate the effectiveness and role of laparoscopy in the management of blunt abdominal trauma patients. Patients and Methods Observational prospective cohort study. Ain Shams University Surgery Hospital. All isolated blunt abdominal trauma patients at Ain Shams University Surgery hospital from 1/3/2019 to 1/9/2019. Eligibility and exclusion criteria applied as following: Eligibility criteria All patients with blunt abdominal trauma presented to ASUH. Patients with class I &class II according to ATLS guidelines for hemorrhagic shock in trauma patients. Patients aged 18 years old or above. Exclusion criteria: Patients with class III &class IV according to ATLS guidelines for hemorrhagic shock in trauma patients. Pregnant patients. Patients with old trauma presented after 24 hours. Patients discharged on demand. Results Laparoscopy decreased the operative time in comparison with laparotomy, the mean operative time for patients underwent laparoscopy is 123.28 minutes while in patients underwent laparotomy is 150.48. Also, time to pass gas post operative after laparoscopy is 1-3 days compared to 2-4 days after laparotomy which is in favor of laparoscopy which is associated with rapid recovery of patients. Laparoscopy is associated with decreased post operative ICU stay (1-3) days in comparison with Laparotomy (2-5) days and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, 2 patients with respiratory tract infections after laparoscopy and no mortality while six patients with respiratory tract infections, 6 patients with wound infection, one patient with deep venous thrombosis and 2 patients died after laparotomy. Conclusion Laparoscopy is found to be a good alternative to laparoscopy, as it is considered to be reliable and safe as a diagnostic and treatment method in hemodynamically stable patients with blunt abdominal trauma, it can be used to reduce the laparotomy rate, and it is associated with lower morbidity and mortality.