ROLE OF LAPAROSCOPY TO OBVIATE LAPAROTOMY IN VIOLATING ABDOMINAL STAB WOUNDS IN HEMODYNAMICALLY STABLE PATIENT

Abstract

Background: Abdominal trauma one of the main series proplem faced in emergency room it is management is directly related to the incidence of morbidity and mortality Laparoscopy approach has gained wide acceptance among all surgeon.Aim of the work: To study role of laparoscopy in management of violating abdominal stab wounds in hemodynamically stable patients regarding current applications, advantages, disadvantages and future developments. Patients and methods: This prospective nonrandomized clinical study included 80 patients who presented to Ain Shams emergency unit with anterior abdominal stab wound(s) during the period from January 2018 till January 2019. Informed consent regarding conservative management or the need for diagnostic laparoscopy / laparotomy was obtained from all patients.Results: In our study results of 80 patients showed 15 patients (18.8%) were negative without intraabdominal lesion.65 patients (81.3%) had positive finding 46 patients (57.5%) were managed by laparoscopy and 19 patients (23.8%) were converted to open surgery.46 patients were managed by laparoscopy 12 (15%) patients underwent repair of serosal and small tears with simple intracoporcal suturing.10 patients (12.5%) with omental injury, cauterization was done to the 8 patients and clipping of omental bleeder in 2 patients was done.8 patients (10%) with gastric tear were repaired by intracoporial suturing.11 patients (13.8%) with liver injury, haemostasis was done by cauterization and gel foam.5 patients with left colonic and sigmoid injuries underwent lap. colostomy.Conclusion: Exploratory laparoscopy applied to carefully selected hemodynamically stable penetrating trauma patients proved to be safe and technically feasible. It also reduced the negative and non-therapeutic laparotomies and offered profound therapeutic potential and cost effectiveness. So 61 patients (76.3%) ovoid unnecessary laparotomy [15 negative (8.8%) + 46 (57.5%) underwent laparoscopic management] so it's proved to both diagnostic and therapeutic role