Abstract
Laparoscopy has been used for the diagnosis and treatment for hemodynamically stable patients with penetrating abdominal trauma. This study evaluated whether diagnostic and therapeutic laparoscopy can be used as effectively in select patients with blunt abdominal trauma. All hemodynamically stable patients undergoing operations for blunt abdominal trauma over a 10-year period (2006–2015) at a tertiary medical center were included. Patients undergoing laparotomy were categorized as group A. Patients who underwent laparoscopy were categorized as group B. The clinical outcomes of the 2 groups were compared. There were 139 patients in group A and 126 patients in group B. Group A patients were more severely injured (mean injury severity score of 23.3 vs. 18.9, P < .001) and had a higher frequency of traumatic brain injuries (25.2% vs. 14.3%, P = .039). The sensitivity and specificity of diagnostic laparoscopy for patients in group B was 99.1% and 100.0%, respectively. No non-therapeutic laparotomies were performed in group B, and the success rate of therapeutic laparoscopy was 92.0% (103/112) for patients with significant intra-abdominal injuries. Patients in the 2 groups had similar perioperative and postoperative outcomes in terms of operation times, blood loss, blood transfusion requirements, mortality, and complications (all, P > .05). Laparoscopy is a feasible and safe tool for the diagnosis and treatment of hemodynamically stable patients with blunt abdominal trauma who require surgery.
Highlights
In the era of minimally invasive surgery (MIS), laparoscopy is used in the management of abdominal trauma, but recommendations at the evidence level cannot be made because no randomized controlled trials have been available [1,2]
The actual role of therapeutic laparoscopy for patients with blunt abdominal trauma (BAT) remains undefined because the study focused on select indications in a limited number of patients and compared patients using an open approach on the basis of historical cohorts
We retrospectively reviewed the medical records of all patients with BAT from the trauma registry database at a single center, where trauma surgeons were responsible for trauma and acute care surgeries
Summary
In the era of minimally invasive surgery (MIS), laparoscopy is used in the management of abdominal trauma, but recommendations at the evidence level cannot be made because no randomized controlled trials have been available [1,2]. Reports have indicated that therapeutic laparoscopy can be successfully applied in select patients with varied intra-abdominal injuries, including those of the diaphragm, liver, spleen, and gastrointestinal tract [7,9]. For patients with blunt abdominal trauma (BAT), the role of laparoscopy is even less clear than for those with PAT due to relatively fewer reports [10]. Laparoscopy, could be beneficial in some select situations, such as for patients with isolated intra-abdominal fluid accumulation of uncertain origin shown on computed tomography (CT) scans [13]. Our previous studies suggest the benefits of laparoscopy in avoiding the need of laparotomy for select patients with BAT, except for those with spleen injuries [13,15]. The actual role of therapeutic laparoscopy for patients with BAT remains undefined because the study focused on select indications in a limited number of patients and compared patients using an open approach on the basis of historical cohorts
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