0046 Endo
THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA
Roye Inbar, Ron Greenberg, Boaz Sagie, Moshi Simcha, Ami Mayo, Dror Sofer,
Shmuel Avital
Trauma Unit, Tel-Aviv Medical Center and the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
Introduction: The exact role, safety and benefits of laparoscopy in abdominal
trauma, are not well defined
Purpose: To better define the role of laparoscopy in abdominal trauma patients
with reference to indications, safety and benefits.
Methods: A retrospective review of all patients who sustained abdominal trauma
and underwent laparoscopy as part of their evaluation and management in the
recent 18 months.
Results: There were 17 patients. All were males. Mean age was 31 years.
Mechanism of injury was: penetrating trauma in 15 patients (88%) and blunt in two
(12%). All patients were hemodynamically stable and had no signs of peritonitis
when referred to surgery. Indications for laparoscopy , intra-operative findings and
outcome are summarized in the table:
Indication
Penetrating trauma - Assessing
peritoneal violation
Penetrating trauma -assessing
intra-abdominal injuries
following positive findings in
imaging studies
Blunt Trauma Equivocal findings in CT scan
No.
Patients
7 (41%)
8 (47%)
2 (12%)
Intra-operative Findings
4 – no peritoneal violation
1 - peritoneal violation, negative
laparoscopy
2 – peritoneal violation and
conversion
2 – laparoscopic suturing of left
diaphragm and spleen hemostasis
1 – negative laparoscopy
5 – conversion
1 – negative laparoscopy
1- conversion
53% of cases (9/17) had laparoscopy only. 41% (7/17) had diagnostic laparoscopy
and 12% (2/17) had therapeutic laparoscopy. Eight (47%) patients were converted
to open, 6 of them underwent therapeutic laparotomy and 2 negative. There was no
moetality, no injuries were missed and no patients required re-operation. There
were no wound infections in the laparoscopic completed group and 2 wound
infections in the converted cases. Mean hospital stay was 6 days.
Conclusions: Laparoscopy is a safe method in the evaluation and management of
penetrating abdominal trauma. Indications include assessing violation of
peritoneum, and diagnostic and therapeutic laparoscopy in the presence of
suspected injuries by imaging studies. It can prevent unnecessary negative
laparotomies and replace therapeutic laparotomies in specific injuries such as left
diaphragmatic tears.