ROLE OF LAPAROSCOPY IN MANAGEMENT OF ABDOMINAL TRAUMA

Abstract

Background: Abdominal trauma affects 10% to 15% of injured patients. Although significant intra-abdominal injury is relatively infrequent, the consequences of missed or delayed diagnosis can be significant. Therefore, accurate and timely diagnosis of injuries is essential. Objective: To study the feasibility, the advantages, and the disadvantages of laparoscopy in diagnosis and treatment of abdominal trauma. Patients and Methods: This randomized prospective study included 50 patients with abdominal trauma of any type whether blunt or penetrating, road traffic accident (RTA) or falling from height, stab or gunshot. Mean age was of patients was 29.26±8.55 years old and mean BMI was 26.36±3.12. Ninety eight percent of them were males and 2% of them were females. Results: The intraoperative bleeding occurred in one patient (2%). Female patient presented after lower abdominal stab wound (BP 90/50 -HB 8 –HR 120). After resuscitation diagnostic laparoscopy found uncontrolled bleeding from uterine tear. Post-operative complications occurred in 8% post laparotomy and 14% post laparoscopy. Patients underwent laparotomy delayed in return to daily activity (8-9 days) and to work (12-24 days) due to time of operation, length of incision and occurrence of complications and depended on age, BMI, power of healing and intraoperative technique. In our experience, the use of laparoscopy as a diagnostic and therapeutic tool led to avoidance of an open surgery in more than 64% of patients. Negative and non-therapeutic laparoscopies were performed in 7 patients and therapeutic laparoscopy was performed in 25 patients: 8 patients hand assisted splenectomy, 5 patients needed repair of liver tears, 3 patients needed diaphragmatic tear repair, 7 patients needed primary repair for bowel and 2 patients needed stomach repair. However, conversion to laparotomy was needed in 18 cases more than 30%. Multiple organ injuries occurred in 16%, colostomy for descending and sigmoid colonic tears (10%), resection anastomosis for multiple small bowel injuries (2%), repair for uterine injuries (2%). Conclusion: The keys to successfully diagnosing and treating significant intra-abdominal injuries laparoscopically include a systemic exploration to avoid missed injuries using appropriate changes in position of the patient, careful planning of port placement. Minimally invasive surgery has become a useful tool in the management of trauma. Laparoscopy can detect and repair injuries to the hollow viscus and diaphragm and exclude the risks of non-therapeutic laparotomy. Further advantages are reduced morbidity, shortened hospital stay, and lower cost. In the future, there may be exciting advancements for this field of surgery through innovative developments.