LAPAROSCOPIC SURGERY FOR TRAUMA: THE REALM OF THERAPEUTIC
MANAGEMENT
Syed Nabeel Zafar, Kakra Hughes, Edward E. Cornwell, III, Terrence M. Fullum, and Daniel D. Tran.
Department of Surgery, Howard University College of Medicine, Washington, DC.
Background: Laparoscopic surgery has become the standard of care for several types of operative
treatment. The role of diagnostic laparoscopy in trauma has been examined; however, the therapeutic
value of laparoscopic surgery in trauma settings has not been explored.
Objectives: To evaluate the use of therapeutic laparoscopic surgical management in trauma patients
from a national trauma data set.
Methods: We analyzed the National Trauma Databank years 2007 to 2010 for all patients with an
isolated injury to abdomen who had a diagnostic laparoscopy. From the ICD 9 procedure codes we
determined the number of patients who underwent any other major operative procedure besides
diagnostic laparoscopy and categorized these as either open or laparoscopic. Descriptive analyses were
performed and the frequencies of different laparoscopic procedures were tabulated. Mortality and hospital
length of stay was compared between the open and laparoscopic groups using the Fisher’s exact test and
the Mann-Whitney U test.
Results: Out of a total of 2,539,818 trauma visits in the NTDB, 163,065 (6.4%) had isolated abdominal
injuries. 2,294 (1.4%) of these underwent a diagnostic laparoscopy and of those, 716 (31.2%)
underwent at least one therapeutic operative procedure. 376 (52.5%) of these patients were managed
laparoscopically. Frequencies of common laparoscopic procedures are presented in table 1. Three
people died in the open group (0.88%) while One person died (0.27%) in the laparoscopic group (0.355).
Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5
days vs 6 days; p value <0.001).
Conclusion: Therapeutic laparoscopic surgery for trauma is feasible and may even provide better
outcomes.
Table 1: Common therapeutic laparoscopic surgeries performed for trauma.
Surgery
Gastrostomy
Peritoneal lavage
Repair of large bowel laceration
Repair of small bowel laceration
Small bowel resection
repair of liver laceration
Splenectomy
Repair of stomach laceration
Large bowel resection
Repair of mesentery
Foreign body removal
No of
Percentage
patients
132
35.1
74
19.7
74
19.7
69
18.4
64
17.0
49
13.0
48
12.8
44
11.7
44
11.7
37
9.8
31
8.2