Abstract
Purpose: In this study we aimed to investigate the safety and effectivity of diagnostic laparoscopy (DL) as an alternative to traditional exploratory laparotomy. Materials and Methods: A total of 104 patients with penetrating abdominal trauma admitted to our department between July 2001 and September 2005 were retrospectively analyzed. Results: Exploratory laparotomy was performed in 85 patients with the results of negative in 3 patients and non-therapeutic in 7 patients. Diagnostic laparoscopy was performed in 11 patients and peritoneal penetration was detected in 6. Two patients were converted to laparotomy due to visceral injury. No missed injuries or laparoscopy related complications were detected during follow up. Age, sex, mechanism of injury and injury severity scores were not statistically significant between the groups of diagnostic laparoscopy and unnecessary laparotomy (p>0,05). The mean length of stay was significantly lower in DL group (p<0,05). Conclusion: Diagnostic laparoscopy in penetrating abdominal traumas is a safe method with high accuracy and can diminish the length of stays in hospital by preventing unnecessary laparotomies.
Keywords:
Penetrating abdominal trauma, diagnostic laparoscopy, trauma
References
1
Fabian TC, Croce MA. Abdominal trauma, including indications for celiotomy. In: Mattox KL., Feliciano DV., Moore EE. Trauma, 4.Baskı. McGraw Hill 2000; 583 – 602.
2
Leppäniemi A, Haapiainen R. Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study. J Trauma 2003;55:636-645.
3
Cameron P, Civil I. The management of anterior abdominal stab wounds in Australasia. Aust N Z J Surg 1998;68:510-513.
4
Demetriades D, Rabinowitz B. Selective conservative management of penetrating abdominal wounds: a prospective study. Br J Surg 1984;71:92-94.
5
Ahmed N, Whelan J, Brownlee J, et al. The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg 2005;201:213-216.
6
Marks JM, Youngelman DF, Berk T. Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 1997;11:272-276.
7
Weinberg JA, Magnotti LJ, Edwards NM, et al. “Awake” laparoscopy for the evaluation of equivocal penetrating abdominal wounds. Injury 2007;38:60-64.
8
Ditmars ML, Bongard F. Laparoscopy for triage of penetrating trauma: the decision to explore. J Laparoendosc Surg 1996;6:285-291.
9
Fabian TC, Croce MA, Stewart RM, et al. A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg 1993;217:557-564; Discussion 564-565.
10
Ortega AE, Tang E, Froes ET, et al. Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries. Surg Endosc 1996;10:19-22.
11
Miles EJ, Dunn E, Howard D, et al. The role of laparoscopy in penetrating abdominal trauma. JSLS 2004;8:304-309.
12
Ivatury RR, Simon RJ, Stahl WM. A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 1993;34:822-827; discussion 827-828.
13
Chelly MR, Major K, Spivak J, et al. The value of laparoscopy in management of abdominal trauma. Am Surg 2003;69:957-960.
14
Guth AA, Pachter HL. Laparoscopy for penetrating thoracoabdominal trauma: pitfalls and promises. JSLS 1998;2:123-127.
15
Cherry RA, Eachempati SR, Hydo LJ, et al. The role of laparoscopy in penetrating abdominal stab wounds. Surg Laparosc Endosc Percutan Tech 2005;15:14-17.
16
Zantut LF, Ivatury RR, Smith RS, et al. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 1997;42:825-829; discussion 829-831.
17
Demetriades D, Hadjizacharia P, Constantinou C, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006;244:620-628.
18
Sauerland S, Agresta F, Bergamaschi R, et al. Laparoscopy for abdominal emergencies: evi-dence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006;20:14-29.
19
Ross SE, Dragon GM, O'Malley KF, et al. Morbidity of negative celiotomy in trauma. Injury 1995; 26: 393–394.
20
Shih HC, Wen YS, Ko TJ, et al Noninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy. World J Surg 1999; 23: 265–270.
21
Ertekin C, Yanar H, Taviloglu K, et al. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J 2005;22:790-794.
22
Boulanger BR, Kearney PA, Tsuei B, et al. The routine use of sonography in penetrating torso injury is beneficial. J Trauma 2001;51:320-325.
23
Salim A, Sangthong B, Martin M, et al. Use of computed tomography in anterior abdominal stab wounds: results of a prospective study. Arch Surg 2006;141:745-750; discussion 750-752.
24
Sugrue M, Balogh Z, Lynch J, et al. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg 2007;77:614-620.
25
Thacker LK, Parks J, Thal ER. Diagnostic peritoneal lavage: is 100,000 RBCs a valid figure for penetrating abdominal trauma? J Trauma 2007;62:853-857.
26
Kazımi M, Makay O, Fırat O, ve ark. Diagnostik Periton Lavajı; tarihe mi karışıyor? Ege Tıp Dergisi, 2007; 46: 33–36,
27
Sriussadaporn S, Pak-art R, Pattaratiwanon M, et al. Clinical uses of diagnostic peritoneal lavage in stab wounds of the anterior abdomen: a prospective study. Eur J Surg 2002;168:490-493.
28
Friese RS, Coln CE, Gentilello LM. Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma 2005;58:789-792.
29
Simon RJ, Rabin J, Kuhls D. Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma 2002;53:297-302.
30
Dapri G, Himpens J, Lipski D, et al. Role of laparoscopy in the management of visceral injuries following abdominal stab wounds. J Laparoendosc Adv Surg Tech A 2007;17:713-718.
31
Saribeyoglu K, Pekmezci S, Baca B, et al. Laparoscopy offers diagnosis and treatment in abdominal stab injuries. Surg Laparosc Endosc Percutan Tech 2007;17:396-401.
32
Chol YB, Lim KS. Therapeutic laparoscopy for abdominal trauma. Surg Endosc 2003;17:421-427.
33
Sakarya A, Erhan Y, Aydede H, ve ark. Batına penetran kesici-delici alet yaralanmalarında gereksiz laparotomiler. Göztepe Tıp Dergisi 1999; 14: 168 – 170.
