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Alyami R, Alotaibi AE, Almohayya L, Jawad AA, Almukhayzim R, Alhoumedan A, Aldusari RS. Role of laparoscopic surgery in blunt abdominal trauma; retrospective analysis in a tertiary trauma center. BMC Surg 2025; 25:8. [PMID: 39757196 DOI: 10.1186/s12893-024-02744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 12/26/2024] [Indexed: 01/07/2025] Open
Abstract
PURPOSE Trauma is a significant health concern globally and is one of the leading causes of illness and death. The laparoscopic approach has gained popularity in trauma care since its inception, becoming increasingly favored for both diagnostic and therapeutic purposes. This study aims to reduce unnecessary laparotomies and assess the effectiveness of laparoscopy in managing patients with blunt abdominal trauma. METHODS The study is a descriptive retrospective study using the medical records of patients with blunt abdominal trauma who were managed with laparoscopy in the Department of General Surgery, King Abdulaziz Medical City in Riyadh. The study period was from 2019 to 2023 and included patients > 18 years with abdominal blunt injury, hemodynamically stable patients, and responding to resuscitation. The relationship between laparoscopic procedures according to the patient's demographic and characteristics was conducted using the Fischer Exact test and independent sample t-test. Values were considered significant with a p-value of less than 0.05. RESULTS In this study, 74 patients were included, with 94.6% being males. The average age of the patients was 36.3 years (standard deviation of 12.5 years). The primary cause of trauma was motor vehicle accidents (MVAs), accounting for 91.9% of cases. The most common surgical approach used was laparotomy, performed in 71.6% of patients. Additionally, CT scans revealed that solid organ injuries were the most frequently detected type of injury, occurring in 41.9% of cases. Following surgery, 78.4% of the patients underwent therapeutic procedures after laparotomy, while 37.8% received therapeutic interventions post-laparoscopy. CONCLUSION While laparoscopic techniques have been used for decades in abdominal surgeries, a consensus on their effectiveness and accuracy in diagnosing blunt abdominal injuries in trauma settings is still lacking. Laparoscopy is considered safe and feasible for hemodynamically stable patients, and our findings suggest it is equally effective in trauma cases for those who can tolerate the procedure. We recommend conducting further studies with larger sample sizes and more variables to provide sufficient data to accurately assess the efficacy and safety of laparoscopy in trauma situations.
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Affiliation(s)
- Rifan Alyami
- Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahad E Alotaibi
- Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Leen Almohayya
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ajyad Al Jawad
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Raghad Almukhayzim
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abeer Alhoumedan
- College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rakan S Aldusari
- Department of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Özpek A, Yıldırak MK, Ezberci F. Hollow viscus injury due to blunt abdominal trauma: a tertiary trauma center experience. ULUS TRAVMA ACIL CER 2024; 30:123-128. [PMID: 38305660 PMCID: PMC10977501 DOI: 10.14744/tjtes.2024.67249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Hollow viscus injuries (HVIs) present less frequently than solid organ injuries in patients with blunt abdominal trauma, potentially leading to significantly increased morbidity and mortality rates. Modern imaging equipment, confidently used for diagnosing solid organ injuries, may fail to identify hollow viscus injuries. In this study, we aim to present our tertiary center's experience with this entity. METHODS Patients treated in our clinic from April 2011 to December 2021 for hollow viscus injury following blunt abdominal trauma were included in this study. We recorded and retrospectively evaluated patients' demographic data, injury site and mechanism, preoperative and perioperative findings, and mortality rates in a prospective database. RESULTS Of the 607 blunt trauma patients, 35 (5.8%) had hollow viscus injuries, with 88.6% being male. Motor vehicle accidents were the leading cause of injury (80%). The mean duration between admission and surgical exploration was 26±21.2 hours. The mean Injury Severity Score was 21.8±13.6. Rigidity was the most frequent clinical finding (60%). The jejunum and ileum were the most frequently injured organs (54.1%). Mortality and morbidity rates were 11.4% and 17.1%, respectively. CONCLUSION Nondeclining white blood cell (WBC) counts within 24 hours of admission, alongside any physical or radiological finding indicating an HVI, should prompt immediate surgical exploration.
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Affiliation(s)
- Adnan Özpek
- Department of General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Muhammed Kadir Yıldırak
- Department of General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul-Türkiye
| | - Fikret Ezberci
- Department of General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul-Türkiye
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Sylivris A, Liu ZF, Shakerian R, Loveday BPT, Read DJ. Paradigms in trauma laparoscopy for anterior abdominal stab wounds: A scoping review. Injury 2024; 55:111298. [PMID: 38160522 DOI: 10.1016/j.injury.2023.111298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Anterior abdominal stab wounds (AASW) are a heterogeneous presentation with evolving management over time and heterogenous practice between centres. The aim of this scoping review was to identify, characterise and classify paradigms for trauma laparoscopies for AASW. METHODOLOGY Studies were screened from Embase, Medline, Scopus, Cochrane Library and Web of Science from 1 January 1947 until 1 January 2023. Extracted data included indications for trauma laparoscopies vs laparotomies, and criteria for conversion to an open procedure. RESULTS Of 72 included studies, 35 (48.6 %) were published in the United States, with an increasing number from South Africa since 2014. Screening tests to determine an indication for surgery included local wound exploration, computed tomography, and serial clinical examination. Two studies proposed no absolute contraindications to laparoscopy, whereas most papers supported trauma laparoscopies over laparotomies in hemodynamically stable patients with positive or equivocal screening tests. However, clinical decision trees were used inconsistently both between and within many hospital centres. Triggers for conversion to laparotomy were diverse. Older studies typically reported conversion if peritoneal breach was identified. More recent studies reported advances in technical skills and technology allowed attempt at laparoscopic repair for organ and/or vascular injury. CONCLUSION This review emphasises that there are many different paradigms of practice for AASW laparoscopy, which are evolving over time. Significant heterogeneity of these studies highlights that meta-analysis of outcomes for trauma laparoscopy is not appropriate unless the included studies report homogenous treatment paradigms and patient cohorts. The decision to perform a trauma laparoscopy should be based on surgeon/hospital experience, patient factors, and resource availability.
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Affiliation(s)
- Amy Sylivris
- Department of General Surgery, Royal Melbourne Hospital, Victoria, Australia.
| | | | - Rose Shakerian
- Department of General Surgery, Royal Melbourne Hospital, Victoria, Australia
| | - Benjamin P T Loveday
- Department of General Surgery, Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, University of Melbourne, Victoria, Australia
| | - David J Read
- Department of General Surgery, Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, University of Melbourne, Victoria, Australia
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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Damous SHB, Menegozzo CAM, VON-Bahten LC, Utiyama EM. Laparoscopy in Trauma: Can Brazil fit into the global trend? Rev Col Bras Cir 2023; 50:e20233602EDIT01. [PMID: 37851760 PMCID: PMC10519700 DOI: 10.1590/0100-6991e-20233602edit01-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/31/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Sergio Henrique Bastos Damous
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Carlos Augusto Metidieri Menegozzo
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Luiz Carlos VON-Bahten
- - Pontífica Universidade Católica do Paraná, Cirurgia - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Cirurgia - Curitiba - PR - Brasil
| | - Edivaldo Massazo Utiyama
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia Geral e Trauma - São Paulo - SP - Brasil
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Corbitt M, Schmidt E, Swift K, O'Neill J, Brunott N. Overview of stab injuries in Far North Queensland: A new insight into the demographics, injury patterns and management. Injury 2022; 54:1386-1391. [PMID: 36604289 DOI: 10.1016/j.injury.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ. METHODS A five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021. RESULTS 214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n = 81) and the chest/thorax (n = 77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n = 8), colon (n = 5) and stomach (n = 2), whilst the liver was the most frequently injured solid organ (n = 6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths. CONCLUSION Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.
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Affiliation(s)
- Matthew Corbitt
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia; School of Medicine & Dentistry, Griffith University, Parklands Drive, Gold Coast, QLD, Australia.
| | - Emily Schmidt
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
| | - Kate Swift
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia; Faculty of Medicine, University of Queensland, 288 Herston Road, St Lucia, QLD, Australia
| | - John O'Neill
- Department of Emergency Medicine, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
| | - Nathan Brunott
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
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Elkbuli A, Newsome K, Fanfan D, Sutherland M, Bilski T, Liu H, Ang D. Laparoscopic Versus Laparotomy Surgical Interventions for Trauma Patients With Single Upper Left Quadrant Penetrating Injuries: Analysis of the American College of Surgeons Trauma Quality Improvement Program Dataset. Am Surg 2022; 88:2182-2193. [PMID: 35592893 DOI: 10.1177/00031348221101510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aim to identify patient cohorts where laparoscopy can be safely utilized with comparable or better outcomes to laparotomy among patients with single penetrating LUQ injuries with a hypothesis that compared to laparotomy, laparoscopy may be associated with equal or improved outcomes of low injury severity patients. METHODS Retrospective review of the ACS-TQP-Participant Use File 2016-2019 dataset. Patients with single LUQ penetrating injuries were included. Primary outcome was risk-adjusted in-hospital mortality. Secondary outcomes included: risk-adjusted complication rates, hospital length-of-stay (H-LOS), and ICU-LOS. Descriptive statistics and multivariable regression with reliability adjustments to account for variations in practice were performed. RESULTS Of 4149 patients analyzed, 3571 (86.1%) underwent laparotomy, 489 (11.8%) underwent laparoscopy, and 89 (2.1%) underwent laparoscopy-to-laparotomy conversion. Adjusted mortality rates were not significantly different among all study cohorts (P > .05). Compared to laparoscopy, adjusted odds of complications were 4.3-fold higher for all patients who underwent laparotomy and 4-fold higher for laparoscopy-to-laparotomy (LtL) patients (P < .05). Diaphragmatic injuries were associated with significantly increased odds of undergoing LtL, whereas sustaining a colonic injury, gastric injury, hepatic injury, or requiring PRBC transfusions were associated with significantly increased odds of undergoing laparotomy (P < .05). H-LOS (days) was significantly longer for patients who underwent laparotomy compared to laparoscopy (3.9 ± 4.0 vs. 10.8 ± 13.4, P < .0001). CONCLUSIONS Laparoscopy may be considered a viable alternative to laparotomy for hemodynamically stable adult patients with single penetrating LUQ injuries of low injury burden validating our hypothesis. Laparoscopy may be less safe for patients with associated diaphragmatic, colonic, or hepatic injuries.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Division of Medical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Kevin Newsome
- 5450Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Dino Fanfan
- 5450Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Mason Sutherland
- 2814NSU NOVA Southeastern University, Dr. Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Division of Medical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Huazhi Liu
- Department of Surgery, Division of Trauma and Surgical Critical Care, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Darwin Ang
- Department of Surgery, Division of Trauma and Surgical Critical Care, 23703Ocala Regional Medical Center, Ocala, FL, USA
- University of South Florida, Tampa, FL, USA
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Cheng V, Schellenberg M, Ashbrook M, Grigorian A, Donohue S, Emigh B, Matsushima K, Inaba K. Predictors of Clinical Outcomes Following Laparoscopic Colectomy for Traumatic Injury. Am Surg 2022; 88:2486-2492. [PMID: 35549734 DOI: 10.1177/00031348221101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laparoscopic colectomy following traumatic injury has been increasingly utilized, but open resection remains the standard of care. Therefore, identifying appropriate candidates for laparoscopy is critically important. This study's purpose was to identify predictors of clinical outcomes in patients undergoing laparoscopic colectomy following traumatic injury. METHODS The National Trauma Databank was queried for patients undergoing laparoscopic colectomy within 48 hours of admission between 2007 and 2015. Patient, injury, and management characteristics were abstracted. Multivariable regression analyses adjusted for baseline characteristics and identified significant predictors of clinical outcomes. RESULTS A total of 581 patients satisfied inclusion criteria. The median age was 31 years, 465 (80%) were male, and 321 (55%) sustained penetrating injuries. An ostomy was created in 143 (25%) cases. Multivariable logistic regression showed that significant predictors of mortality included a falling mechanism (odds ratio [OR] 104.917, P = .002), admission tachycardia (OR 5.823, P = .001), admission hypotension (OR 26.089, P < .001), and multi-system injuries like head (OR 1.587, P = .008) and thoracic (OR 1.627, P = .001) injuries. Significant predictors of unplanned reoperation included transverse (OR 7.657, P = .033) and left (OR 17.155, P = .014) colon resections, obesity (OR 24.407, P = .016), and chronic respiratory disease (OR 32.963, P = .018). Ostomy creation was significantly associated with neither mortality nor unplanned reoperation. CONCLUSION These data suggest that readily identifiable preoperative characteristics are significantly associated with differences in clinical outcomes. Additional research is required to determine if varying treatment based on these qualities can improve outcomes.
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Affiliation(s)
- Vincent Cheng
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Matthew Ashbrook
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Areg Grigorian
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Sean Donohue
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Brent Emigh
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, 23336LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA Presented at the 2022 Annual Scientific Conference of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA
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Wang J, Cheng L, Liu J, Zhang B, Wang W, Zhu W, Guo Y, Bao C, Hu Y, Qi S, Wang K, Zhao S. Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:817134. [PMID: 35350141 PMCID: PMC8957831 DOI: 10.3389/fsurg.2022.817134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
Background There is still no consensus regarding the role of laparoscopy in trauma cases. The purpose of this paper is to assess the value of diagnostic and therapeutic laparoscopy for patients with blunt or penetrating abdominal trauma by performing a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane library were systemically searched for the randomized controlled trials (RCTs) and non-RCT comparative studies on effectiveness and safety of laparoscopy vs. laparotomy for the two authors independently performed the search, data extraction, and quality assessment. Results A total of 5,517 patients were enrolled in 23 eligible studies that were published in English. Meta-analysis results suggest that there is no significant difference in the incidence of missed injury and mortality between abdominal trauma patients receiving laparoscopy and those receiving laparotomy. Concerning postoperative complications, compared with patients in the open surgery group, those in the laparoscopy group are at a similar risk of intra-abdominal abscesses, thromboembolism, and ileus, while there is a decreased incidence of wound infection and pneumonia. Besides, patients in the laparoscopy group experience shorter hospitalization times and procedure times. For most outcomes, the sensitivity analysis yielded similar results to the primary analysis. Conclusion Laparoscopic surgery is a practical alternative to laparotomy for appropriate patients. The decision to perform laparoscopy should be based on the experience of the surgeon and the resources available.
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Affiliation(s)
- Jianjun Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Liangwang Cheng
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Jing Liu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Binyin Zhang
- Department of Endocrine, Taihe People's Hospital, Fuyang, China
| | - Weijun Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Wenxin Zhu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Yan Guo
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Chuanfei Bao
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Yunli Hu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Shanxin Qi
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Kai Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Shuguang Zhao
- Department of Emergency, Taihe People's Hospital, Fuyang, China
- *Correspondence: Shuguang Zhao
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10
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Smyth L, Bendinelli C, Lee N, Reeds MG, Loh EJ, Amico F, Balogh ZJ, Di Saverio S, Weber D, Ten Broek RP, Abu-Zidan FM, Campanelli G, Beka SG, Chiarugi M, Shelat VG, Tan E, Moore E, Bonavina L, Latifi R, Hecker A, Khan J, Coimbra R, Tebala GD, Søreide K, Wani I, Inaba K, Kirkpatrick AW, Koike K, Sganga G, Biffl WL, Chiara O, Scalea TM, Fraga GP, Peitzman AB, Catena F. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment. World J Emerg Surg 2022; 17:13. [PMID: 35246190 PMCID: PMC8896237 DOI: 10.1186/s13017-022-00418-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023] Open
Abstract
The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.
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Affiliation(s)
- Luke Smyth
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
| | - Nicholas Lee
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Matthew G Reeds
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Eu Jhin Loh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Dieter Weber
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Fikri M Abu-Zidan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Solomon Gurmu Beka
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Massimo Chiarugi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Vishal G Shelat
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Edward Tan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Ernest Moore
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Luigi Bonavina
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Rifat Latifi
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andreas Hecker
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Jim Khan
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Raul Coimbra
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Giovanni D Tebala
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kjetil Søreide
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Imtiaz Wani
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Kenji Inaba
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Kaoru Koike
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriele Sganga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Walter L Biffl
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Osvaldo Chiara
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Thomas M Scalea
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Gustavo P Fraga
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Andrew B Peitzman
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Fausto Catena
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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11
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Lodhia J, Msuya D, Chilonga K, Makanga D. Successful Transabdominal Removal of Penetrating Iron Rod in the Rectum: A Case Report. East Afr Health Res J 2022; 5:137-141. [PMID: 35036838 PMCID: PMC8751478 DOI: 10.24248/eahrj.v5i2.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Foreign bodies in the anus and rectum are not uncommon presentations globally. Reasons for foreign bodies in the rectum can be trauma, assault, psychiatric reasons but the most common reason documented is sexual pleasure, and objects range from sex toys to tools to packed drugs. Regardless of the reason, health care providers must maintain nonjudgmental composure and express empathy. Numerous cases have been reported of anorectal foreign body due to various causes. Removal of the objects has mostly been through rectally but some does need surgical intervention. A multidisciplinary approach and radiologic investigations are important to guide in the management outline. Establishment of guidelines for anorectal foreign bodies are needed to guide surgeons and emergency physicians on the course of treatment. We present a case of an eleven-year old school boy slid and fell on an iron rod that penetrated his rectum through his anal canal. Presented with clinical features of peritonitis, where emergency laparotomy was done and the iron rod was extracted abdominally with primary repair of the rectum. The boy recovered well and was discharged four days after with no complications.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Kondo Chilonga
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi Tanzania.,Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Danson Makanga
- Department of General Surgery, Mpeketoni Hospital, Lamu County, Kenya
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12
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Haratian A, Grigorian A, Rajalingam K, Dolich M, Schubl S, Kuza CM, Lekawa M, Nahmias J. Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers. Am Surg 2022:31348211033535. [DOI: 10.1177/00031348211033535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.
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Affiliation(s)
- Aryan Haratian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Karan Rajalingam
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Matthew Dolich
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA
| | - Michael Lekawa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
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13
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Karsanov AM, Maskin SS, Aleksandrov VV, Matyukhin VV. [Advantages of laparoscopic technologies for blunt abdominal trauma: a systematic review and meta-analysis]. Khirurgiia (Mosk) 2022:86-96. [PMID: 35593633 DOI: 10.17116/hirurgia202205186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the effectiveness of laparotomy and laparoscopy in the treatment of patients with blunt abdominal trauma. MATERIAL AND METHODS Literature searching was conducted in accordance with the recommendations «Preferred Reporting Items for Systematic Reviews and Meta-Analyses» between January 2015 and August 2021. We used the electronic databases PubMed, Cochrane Library, Scopus, eLibrary. RESULTS Laparoscopy reduces hospital-stay, postoperative morbidity and mortality in hemodynamically stable patients with blunt abdominal trauma compared to laparotomy. CONCLUSION Further systematic reviews and meta-analyses of randomized controlled trials are required to obtain high quality data.
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Affiliation(s)
- A M Karsanov
- North Ossetian State Medical Academy, Vladikavkaz, Russia
| | - S S Maskin
- Volgograd State Medical University, Volgograd, Russia
| | | | - V V Matyukhin
- Volgograd State Medical University, Volgograd, Russia
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14
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Jo H, Kim DH. Diagnostic and Therapeutic Laparoscopy for Abdominal Trauma: A Single Surgeon’s Experience at a Level I Trauma Center. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PurposeLaparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon’s experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients. MethodsIn total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages. ResultsThe mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups. ConclusionsLaparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.
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15
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Kommunuri JS, Loto-Aso E, Harmston C. Incidence, outcomes and effect of delayed intervention in patients with hollow viscus injury due to major trauma in the Northern region of New Zealand. ANZ J Surg 2021; 91:1148-1153. [PMID: 33928741 DOI: 10.1111/ans.16883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with hollow viscus injury (HVI) are often a cause for diagnostic uncertainty. The incidence and outcomes of patients suffering hollow viscus injury secondary to major trauma have not been previously described in New Zealand. These metrics are important to guide quality improvement and resource allocation. The aim of our study is to define the incidence, outcomes and effect of delayed intervention on patients admitted to hospital with hollow viscus injury secondary to blunt abdominal trauma in the Northern region of New Zealand. METHODS A 4-year multicentre retrospective study was performed in the Northern region of New Zealand between 1 July 2015 and 30 June 2019. A primary cohort of patients with confirmed hollow viscus injury secondary to blunt abdominal injury, who underwent a laparotomy, were assessed. The primary outcome measures were incidence, 30-day mortality and morbidity. Secondary outcomes included the effect of timing of surgical intervention. RESULTS The incidence of hollow viscus injury in the region was 2.03 per 100 000. The 30-day mortality rate was 5% and the 30-day morbidity rate was 82%. Immediate surgical intervention was carried out in 36%, early surgical intervention in 56% and delayed surgical intervention in 8%. CONCLUSION The incidence of hollow viscus injury is in keeping with similar studies, but with lower mortality and higher morbidity. The rate of immediate or early surgical intervention was high. These findings are important to clinicians managing patients with major trauma and those involved in planning and allocation of resources.
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Affiliation(s)
- Jophia Sushith Kommunuri
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand.,Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | - Eseta Loto-Aso
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand.,Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | - Christopher Harmston
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand.,Auckland District Health Board, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
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16
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Pau L, Navez J, Cawich SO, Dapri G. Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A 2021; 31:1262-1268. [PMID: 33428516 DOI: 10.1089/lap.2020.0552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute to these data by reporting our experience with laparoscopic management of blunt and penetrating trauma in a Belgian center. Materials and Methods: We retrospectively collected data on all trauma patients admitted to the Saint-Pierre University Hospital in Brussels, Belgium, over the 4-year period from January 2014 to December 2017. Hospital records for patients subjected to exploratory laparoscopy were retrospectively reviewed, and a descriptive analysis was reported. Results: There were 26 patients at a mean age of 40 years treated with laparoscopic exploration for injuries from blunt trauma (7), stab wounds (14), and gunshot injuries (5). The median interval between the arrival at the emergency unit and diagnostic laparoscopy was 175 minutes (range: 27-1440), and the median duration of operation was 119 minutes (range: 8-300). In all patients who underwent laparoscopy for trauma, there were 27% overall morbidity, no mortality, 11% reoperation rate, 7.4% conversions, and 19% incidence of negative laparoscopy. The median intensive care unit stay was 3 days (range: 0-41), and median total hospital stay was 7 days (range: 2-78). Conclusions: Laparoscopy is a safe, feasible, and effective tool in the surgical armamentarium to treat hemodynamically stable patients with blunt and penetrating abdominal trauma. It allows complete and thorough evaluation of intra-abdominal viscera, reduces the incidence of nontherapeutic operations, and allows therapeutic intervention to repair a variety of injuries. However, it requires appropriate surgeon training and experience with advanced laparoscopic techniques to ensure good outcomes.
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Affiliation(s)
- Luca Pau
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Department of Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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17
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Chaudhry HH, Grigorian A, Lekawa ME, Dolich MO, Nguyen NT, Smith BR, Schubl SD, Nahmias JT. Decreased Length of Stay After Laparoscopic Diaphragm Repair for Isolated Diaphragm Injury After Penetrating Trauma. Am Surg 2020; 86:493-498. [PMID: 32684037 DOI: 10.1177/0003134820919724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. RESULTS From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications (P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. CONCLUSIONS Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.
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Affiliation(s)
- Haris H Chaudhry
- 23331 Loma Linda University Adventist Health Sciences Center, Loma Linda, CA, USA
| | | | | | | | - Ninh T Nguyen
- 8788 University of California Irvine, Orange, CA, USA
| | - Brian R Smith
- 8788 University of California Irvine, Orange, CA, USA
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18
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Trauma laparoscopy and the six w's: Why, where, who, when, what, and how? J Trauma Acute Care Surg 2020; 86:344-367. [PMID: 30489508 DOI: 10.1097/ta.0000000000002130] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Shamim AA, Zeineddin S, Zeineddin A, Olufajo OA, Mathelier GO, Cornwell Iii EE, Fullum T, Tran D. Are we doing too many non-therapeutic laparotomies in trauma? An analysis of the National Trauma Data Bank. Surg Endosc 2019; 34:4072-4078. [PMID: 31605217 DOI: 10.1007/s00464-019-07169-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma centers have started using diagnostic laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of non-therapeutic laparotomy (NL). We aim to evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL. METHODS Using ICD-9 codes, the National Trauma Data Bank (2010-2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) > 3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications. RESULTS A total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P < 0.01). Rate of penetrating injury was 77% vs 86% for patients in NL vs DL. On multivariate analysis, NL was associated with increased mortality (OR 4.5, 95% CI 2.1-9.7), higher rate of complications (OR 2.2, 95% CI 1.4-3.3), and a longer hospital stay (OR 2.7, 95% CI 2.1-3.5). NL was also associated with higher rates of pneumonia, VTE, ARDS, and cardiac arrest. CONCLUSION With increasing experience in minimally invasive surgery, DL should be a part of the armamentarium of trauma surgeons. This study supports that in well-selected trauma patients DL has favorable outcomes compared to NL. These findings warrant further investigation.
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Affiliation(s)
- Adeel A Shamim
- Department of Surgery, Howard University Hospital, Washington, DC, USA.
- , Room 4B-17, 2041 Georgia Avenue NW, Washington, DC, 20060, USA.
| | | | - Ahmad Zeineddin
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Olubode A Olufajo
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | | | | | - Terrence Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Daniel Tran
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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20
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Martins R, Santos MD, Revez T. Laparoscopy in Blunt Abdominal Trauma: Diaphragmatic and Bladder Lacerations Repair. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ruben Martins
- General Surgery Department, Faro Hospital, Algarve Hospital University Center, Faro, Portugal
| | - Martins dos Santos
- General Surgery Department, Faro Hospital, Algarve Hospital University Center, Faro, Portugal
| | - Tatiana Revez
- General Surgery Department, Faro Hospital, Algarve Hospital University Center, Faro, Portugal
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21
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Zhang H, Du G, Liu YF, Yang JH, A-Niu MG, Zhai XY, Jin B. Overlay of a sponge soaked with ropivacaine and multisite infiltration analgesia result in faster recovery after laparoscopic hepatectomy. World J Gastroenterol 2019; 25:5185-5196. [PMID: 31558866 PMCID: PMC6747283 DOI: 10.3748/wjg.v25.i34.5185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Compared with traditional open surgery, laparoscopic surgery is preferred due to the advantages of less trauma, less pain, and faster recovery. Nevertheless, many patients still suffer from postoperative pain resulting from the surgical incision and associated tissue injury. Many researchers have reported methods to improve postoperative pain control, but there is not a simple and effective method that can be clinically adopted in a widespread manner. We designed this study to prove the hypothesis that application of ropivacaine in the port site and operative site in patients is an effective and convenient method which can decrease postoperative pain and accelerate recovery.
AIM To evaluate the effects of ropivacaine on pain control after laparoscopic hepatectomy and its contribution to patient recovery.
METHODS From May 2017 to November 2018, 146 patients undergoing laparoscopic hepatectomy were randomized to receive infiltration of either 7.5 mg/mL ropivacaine around the trocar insertions, incision, and cutting surface of the liver (with a gelatin sponge soaked with ropivacaine) at the end of surgery (ropivacaine group), or normal saline (5 mL) at the same sites at the end of surgery (control group). The degree of pain, nausea, vomiting, heart rate (HR), and blood pressure were collected. The length of postoperative hospitalization, complications, and the levels of stress hormones were also compared between the two groups.
RESULTS Compared with the control group, the ropivacaine group showed reduced postoperative pain at rest within 12 h (P < 0.05), and pain on movement was reduced within 48 h. The levels of epinephrine, norepinephrine, and cortisol at 24 and 48 h, HR, blood pressure, and cumulative sufentanil consumption in the ropivacaine group were significantly lower than those in the control group (P < 0.05). In the ropivacaine group, hospitalization after operation was shorter, but the difference was not statistically significant. There were no significant differences in postoperative nausea, vomiting, or other complications, including hydrothorax, ascites, peritonitis, flatulence, and venous thrombus (P > 0.05), although fewer patients in the ropivacaine group experienced these situations.
CONCLUSION Infiltration with ropivacaine in the abdominal wound and covering the cutting surface of the liver with a gelatin sponge soaked with ropivacaine significantly reduce postoperative pain and the consumption of sufentanil.
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Affiliation(s)
- Hao Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Gang Du
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yan-Feng Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Jin-Huan Yang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Mu-Guo A-Niu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Xiang-Yu Zhai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Bin Jin
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Laparoscopy versus conventional laparotomy in the management of abdominal trauma: a multi-institutional matched-pair study. Surg Endosc 2019; 34:2237-2242. [DOI: 10.1007/s00464-019-07013-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/19/2019] [Indexed: 01/27/2023]
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Koto MZ, Matsevych OY, Mosai F, Balabyeki M, Aldous C. Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients. J Minim Access Surg 2019; 15:25-30. [PMID: 29483377 PMCID: PMC6293668 DOI: 10.4103/jmas.jmas_199_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. Aim: The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Methods: Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Results: Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4–20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Conclusion: Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.
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Affiliation(s)
- Modise Zacharia Koto
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
| | - Oleh Y Matsevych
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
| | - Fusi Mosai
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Moses Balabyeki
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Colleen Aldous
- University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
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24
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Koto MZ, Matsevych OY, Mosai F, Patel S, Aldous C, Balabyeki M. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg 2018; 108:273-279. [PMID: 30522416 DOI: 10.1177/1457496918816927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. MATERIAL AND METHODS Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. RESULTS A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4-38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. CONCLUSION Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.
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Affiliation(s)
- M Z Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - O Y Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - F Mosai
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - S Patel
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Aldous
- University of KwaZulu-Natal, Durban, South Africa
| | - M Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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25
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Mansour DA, Elshaer AM, Elshazly MAR. A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study. Eur J Trauma Emerg Surg 2018; 46:607-613. [PMID: 30251152 DOI: 10.1007/s00068-018-1015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the role of laparoscopy in such injuries. In this study, we outlined a tailored protocol in the management of penetrating abdominal shotgun injuries differing from the previous protocols which comprised either mandatory exploration or non-operative management. PATIENTS AND METHODS This case-series study included patients who attended to our emergency department with a shotgun injury involving the abdomen between December 2014 and October 2016. Only stable patients with no clinical signs of surgical abdomen, in combination with CT evidence of penetrating intra-abdominal pellets, were subjected to laparoscopic exploration in this study. RESULTS Thirty patients fulfilled the inclusion criteria. During laparoscopy, ten patients were designated as positive for injuries. No missed injuries were identified. Two of the cases identified as positive by laparoscopy needed no further management while the remaining eight patients warranted laparotomy. Only one of these eight patients turned out to have a non-therapeutic exploration. Consequently, laparoscopy in the management of these injuries had an overall accuracy of 96.7%, sensitivity of 100%, specificity of 95.7%, positive predictive value of 87.5% and negative predictive value of 100% with highly significant p value < 0.001. CONCLUSION A tailored protocol relying on the use of laparoscopy in the management of stable patients with CT evidence of penetrating abdominal shotgun injuries is safe and helps to cut down the number of non-therapeutic laparotomies with consequent decrease of complications.
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Affiliation(s)
- Doaa Ahmed Mansour
- Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr Alainy Hospital), 8 NourEldin Bahgat St, Nasr City, Cairo, Egypt.
| | - Ahmed Mohammed Elshaer
- Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr Alainy Hospital), Sama-Cairo block W1, Ring Road, Maadi, Cairo, Egypt
| | - Mostafa Abd-Rahman Elshazly
- Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr-Alainy Hospital), 41 Noubar St, Babelouk, Cairo, Egypt
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26
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Bain K, Meytes V, Chang GC, Timoney MF. Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Surg Endosc 2018; 33:1618-1625. [DOI: 10.1007/s00464-018-6436-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022]
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Laparoscopy for Trauma and the Changes in its Use From 1990 to 2016: A Current Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2018; 28:1-12. [PMID: 28915204 DOI: 10.1097/sle.0000000000000466] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of laparoscopy in the diagnosis and treatment of stable abdominal trauma patients is still a matter of serious debate and only incomplete data are available. MATERIALS AND METHODS We performed a systematic review and meta-analysis of the literature between January 1990 and August 2016. RESULTS Overall, 9817 laparoscopies were performed for abdominal trauma; only 26.2% of the cases were converted to a laparotomy. The incidence of therapeutic laparotomies showed a reduction from 69% to 47.5%, whereas the incidence of therapeutic laparoscopies increased from 7.2% to 22.7%.The overall perioperative mortality rate was significantly lower in the laparoscopy group [odds ratio (M-H, random); 95% confidence interval, 0.35 (0.26-0.48)]. The same group showed shorter length of hospital stay [odds ratio (M-H, random); 95% confidence interval, -3.48 (-8.91 to 1.96)]. CONCLUSIONS This systematic review shows a significant decrease in the use of laparoscopy in trauma patients. Most likely the widespread use of imaging techniques allows a more accurate selection of patients for diagnostic laparoscopy. Infact, a reduction in incidence of nontherapeutic laparotomies is evident in these selected patients undergoing diagnostic laparoscopy. Moreover, the literature reported an increasing trend of therapeutic laparoscopy, demonstrating that it is safe and effective. The small number and poor quality of the studies identified, the retrospective observational nature of the studies (low level of evidence), the high risk of bias, and the high heterogeneity of some outcomes make the applicability of the results of this meta-analysis unclear.
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28
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Lin HF, Chen YD, Chen SC. Value of diagnostic and therapeutic laparoscopy for patients with blunt abdominal trauma: A 10-year medical center experience. PLoS One 2018; 13:e0193379. [PMID: 29470527 PMCID: PMC5823439 DOI: 10.1371/journal.pone.0193379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 02/11/2018] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Heng-Fu Lin
- Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan, R.O.C
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C
| | - Ying-Da Chen
- Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan, R.O.C
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C
- * E-mail:
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Altamimi A, Hassanain M, Nouh T, Ateeq K, Aljiffry M, Nawawi A, Al Saied G, Riaz M, Alanbar H, Altamimi A, Alsareii S, Al-Mousa M, Al-shammari A, Alnuqaydan S, Ghzwany A. Predictors of morbidity and mortality post emergency abdominal surgery: A national study. Saudi J Gastroenterol 2018; 24:282-288. [PMID: 29676288 PMCID: PMC6151994 DOI: 10.4103/sjg.sjg_11_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Emergency surgeries have increased in Saudi Arabia. This study examines these surgeries and associated complications. PATIENTS AND METHODS This was a prospective multicenter cohort study of patients undergoing emergency intraperitoneal surgery from the eight health sectors of Saudi Arabia. Patients' data were collected over 14 days. RESULTS In total, 283 patients were included (163 men [54.06%]). The majority of cases were open surgery (204 vs. 79). The 24 h and 30-day mortality rates for the cohort were 0.7 and 2.47%, respectively. Twenty-nine patients (10.24%) required re-intervention, while 19 (8.12%) needed critical care admission. The median length of hospital stay was 3 days. Multivariate analysis showed American Society of Anesthesiologist (ASA) classification score (P = 0.0003), diagnosis (P < 0.0001), stoma formation (P = 0.0123), and anastomotic leak (P = 0.0015) to correlate significantly with 30-day mortality. CONCLUSION American Society of Anesthesiologist score, diagnosis, stoma formation and anastomotic leak are associated with 30-day mortality after emergency surgery in Saudi Arabia.
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Affiliation(s)
- Afnan Altamimi
- Department of Surgery, King Saud University, Jeddah, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, King Saud University, Jeddah, Saudi Arabia,Address for correspondence: Dr. Hassanain Mazen, Department of Surgery, King Saud University, Riyadh, Saudi Arabia. E-mail:
| | - Thamer Nouh
- Department of Surgery, King Saud University, Jeddah, Saudi Arabia
| | - Khawlah Ateeq
- Department of Surgery, King Saud University, Jeddah, Saudi Arabia
| | - Murad Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar Nawawi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghaith Al Saied
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Riaz
- Department of Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Huda Alanbar
- Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdullah Altamimi
- Department of Surgery, College of Medicine, King Saud bin Abdulaziz University, Riyadh, Saudi Arabia
| | - Saeed Alsareii
- Department of Surgery, Najran University, Najran, Saudi Arabia
| | - Mashael Al-Mousa
- Department of Surgery, College of Medicine, King Faisal University, Dammam, Saudi Arabia
| | - Abeer Al-shammari
- Department of Surgery, College of Medicine, King Faisal University, Dammam, Saudi Arabia
| | - Saleh Alnuqaydan
- Department of Surgery, College of Medicine, Qassim University, Alqassim, Saudi Arabia
| | - Amal Ghzwany
- Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia
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Matsevych O, Koto M, Balabyeki M, Aldous C. Trauma laparoscopy: when to start and when to convert? Surg Endosc 2017; 32:1344-1352. [PMID: 28799045 DOI: 10.1007/s00464-017-5812-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of laparoscopy for stable patients with abdominal trauma is increasing and its accuracy is nearly 100%. However, indications for laparoscopy and for conversion differ among centers. The aim of this study was to investigate indications for trauma laparoscopy and for conversion to laparotomy. METHODS All trauma patients managed with laparoscopy over a 4-year period were retrospectively analyzed. Indications for laparoscopy, morbidity, and reasons for conversion were investigated and predictors of morbidity and conversion were sought. The management algorithm of trauma patients was reviewed and updated. RESULTS Laparoscopy was used in 318 stable trauma patients. Thirty-five patients presented with blunt and 283 with penetrating abdominal injuries. The conversion rate was 11.7% for penetrating and 22.9% for blunt abdominal trauma patients. The most common reason for conversion was continuous intraabdominal bleeding that could not be controlled quickly. It was followed by multiple complex injuries, hemodynamic instability, and intraoperative visualization problems. Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases. There were no missed injuries. Complications occurred in 21.2% in the converted group and in 9.6% in the laparoscopic group. Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH was associated with conversion. CONCLUSION The management of all stable trauma patients with laparoscopy appears to be a safe approach. The use of sound laparoscopic equipment by a well-coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Continuous intraoperative bleeding, complexity of injuries, deterioration of the patient, poor visibility, and equipment failure are indications for conversion.
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Affiliation(s)
- Oleh Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa. .,University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa.
| | - Modise Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa.,University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
| | - Moses Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa
| | - Colleen Aldous
- University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
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31
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Trejo-Ávila ME, Valenzuela-Salazar C, Betancourt-Ferreyra J, Fernández-Enríquez E, Romero-Loera S, Moreno-Portillo M. Laparoscopic Versus Open Surgery for Abdominal Trauma: A Case-Matched Study. J Laparoendosc Adv Surg Tech A 2017; 27:383-387. [PMID: 28253051 DOI: 10.1089/lap.2016.0535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of laparoscopic surgery in abdominal emergencies, such as in trauma, has had a slow acceptance. The advantages described with this approach include less postoperative pain, faster recovery, quicker return to everyday activities, and fewer wound complications. The aim of this retrospective study was to compare outcomes following laparoscopic versus open surgery for abdominal trauma (either blunt or penetrating). MATERIALS AND METHODS Nineteen patients with abdominal trauma who underwent laparoscopic surgery from January 2013 to May 2016 were compared with 19 patients undergoing open surgery during the same time period. Patients were matched (1:1) for age, gender, body-mass index, American Society of Anesthesiologists score, hemodynamic stability, and injury mechanism. Intra- and postoperative variables were compared between groups. RESULTS Laparoscopic group displayed a significantly shorter operative time (93.3 versus 134.2 minutes; P < .009), lower estimated blood loss (100 versus 600 mL; P < .019), faster return to normal diet (1.6 versus 2.4 days; P < .039), and shorter hospital length of stay (LOS) (3.8 versus. 5.6 days; P < .042). There were no statistical significant differences in 30-day mortality between both groups. CONCLUSIONS Laparoscopic surgery for abdominal trauma, either blunt or penetrating, is safe and technically feasible in hemodynamically stable patients. We found in our study that laparoscopic surgery was associated with shorter operative time, lower estimated blood loss, faster return to normal diet, and shorter hospital LOS.
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Affiliation(s)
- Mario E Trejo-Ávila
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
| | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
| | - Jessica Betancourt-Ferreyra
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
| | - Enrique Fernández-Enríquez
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
| | - Sujey Romero-Loera
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, General Hospital "Dr. Manuel Gea González," Mexico City, Mexico
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32
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Pearson EG, Clifton MS. The Role of Minimally Invasive Surgery in Pediatric Trauma. Surg Clin North Am 2017; 97:75-84. [DOI: 10.1016/j.suc.2016.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.
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Affiliation(s)
- Viktor Justin
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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34
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Hajibandeh S, Hajibandeh S, Gumber AO, Wong CS. Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: A systematic review and meta-analysis. Int J Surg 2016; 34:127-136. [DOI: 10.1016/j.ijsu.2016.08.524] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/21/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022]
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35
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Horkan DB, Tashiro J, Wagenaar AE, Perez EA. Laparoscopy in Pediatric Trauma: The Advancement of Minimally Invasive Techniques for Abdominal Trauma. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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