Main Article Content
Abstract
BACKGROUND
In this study, we wanted to evaluate the role of diagnostic laparoscopy in the management of blunt injury to abdomen in hemodynamically stable patients.
METHODS
This was a hospital based prospective observational clinical case study conducted among 30 patients who presented with blunt trauma of abdomen to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L.B. Nagar, Hyderabad, from September 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. The aim of the study is to assess the role of Diagnostic Laparoscopy in the management of Blunt Injury to Abdomen in Hemodynamically Stable patients. Objective of the study were to assess the incidence of Hollow Viscus Injury not detected by clinical or radiological assessment, incidence of persistent bleed and to assess the incidence of Mesentery injury not detected by clinical or radiological assessment.
RESULTS
The most common mode of injury was road traffic accidents (23 cases) 76.66 %, followed by fall from height (3 cases) 9.99 %. Then accidents and assaults which were (2 cases) 2.22 % each. Ongoing bleeding from solid organ injuries was seen intra-operatively in 3 cases (9.99 %). P value = 0.0237 was calculated using Fischer’s exact test and was found to be significant P < 0.05. Most common grade of liver injury was Grade 1- 37.75 % followed by grade 3 - 33.33 %, then grade 2 - 20.8 % and grade 4 - 8.33 %. Grade 1 and grade 2 splenic injuries were more common with 36.36 % (4 cases) each. Followed by grade 3 27.27 % (3 cases). Diagnostic laparoscopy ongoing bleed was noted in 9.99 % (3 cases), followed by mesenteric injury in 6.66 % (2 cases) and hollow viscous perforation in 3.33 % (1 case). Total of 6 therapeutic procedures were done after diagnostic laparoscopy. Out of which, 4 were carried out in laparoscopy (66.66 %) and two were converted from laparoscopy to laparotomy (33.33 %).
CONCLUSIONS
Diagnostic laparoscopy can be carried out in patients of blunt trauma of abdomen, who are hemodynamically stable without any increase in morbidity or mortality. It is a highly useful tool to detect injuries which could not be detected on CT scan. Laparoscopic surgery can be used both as a diagnostic and therapeutic modality. Laparoscopy helps in reducing the negative laparotomies and significant decrease in both morbidity and mortality. With advances in technology and increasing in expertise in laparoscopy, it can be concluded that diagnostic laparoscopy is a valuable modality in the diagnosis and management of patients with blunt trauma to abdomen.
Keywords
Article Details
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References
- Shih HC, Wen YS, KoTJ, et al. Non-invasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy. World J Surg 1999;23(3):265-9.
- Brownstein MR, Bunting T, Meyer AA, et al. Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma. J Trauma 2000;48(3):402-7.
- Javad S, Khadyjeh B, Mehdi S, et al. Diagnostic accuracy of CT scan in abdominal blunt trauma. Chinese J Traumatol 2009;12(02):67-70.
- Killeen KL, Shanmuganathan K, Poletti PA, et al. Helical computed tomography of bowel and mesenteric injuries. J Trauma 2001;51(1):26-36.
- Bhagvan S, Turai M, Holden A, et al. Predicting hollow viscus injury in blunt abdominal trauma with computed tomography.World J Surg 2013;37:123-6.
- Matsushima K, Mangel PS, Schaefer EW, et al. Blunt hollow viscus and mesenteric injury: still underrecognized. World J Surg 2013;37(4):759-65.
- Covey EH. Management of acute trauma. In: Maingot R, Zinner M, eds. Rodney Maingot’s “abdominal operations. 10th edn. Appleton & Lange 1997;6:74-78.
- Malinoski DJ, Patel MS, Yakar DO, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscusinjury. J Trauma 2010;69(1):84-7.
- Lee PC, Lo C, Wu JM, et al. Laparoscopy decreases the laparotomy rate in hemodynamically stable patients with blunt abdominal trauma. Surg Innov 2014;21(2):155-65.
- Lin HF, Chen YD, Lin KL, et al. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries. Am J Surg 2015;210(2):326-33.
- Lim KH, Chung BS, Kim JY, et al. Laparoscopic surgery in abdominal trauma: a single center review of a 7-year experience. World J Emerg Surg 2015;10(1):16.
- Johnson JJ, Garwe T, Raines AR, et al. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center. Am JSurg 2013;205(3):317-20.
- Koto MZ, Matsevych OY, Mosai F, et al. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg 2019;108(4):273-9.
- Bansod AN, Umalkar R, Shyamkuwar AT, et al. A study of role of non-operative management in blunt abdominal trauma with solid organ injury. Int Surg J 2018;5(9):3043-50.
- Wafa A, Elsagier M, Friwan R, et al. Role of Laparoscopy in Abdominal Trauma. Int J Surg Res Pract 2019;6:100.
- Cirocchi R, Birindelli A, Inaba K, et al. 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):1-12.
References
Shih HC, Wen YS, KoTJ, et al. Non-invasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy. World J Surg 1999;23(3):265-9.
Brownstein MR, Bunting T, Meyer AA, et al. Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma. J Trauma 2000;48(3):402-7.
Javad S, Khadyjeh B, Mehdi S, et al. Diagnostic accuracy of CT scan in abdominal blunt trauma. Chinese J Traumatol 2009;12(02):67-70.
Killeen KL, Shanmuganathan K, Poletti PA, et al. Helical computed tomography of bowel and mesenteric injuries. J Trauma 2001;51(1):26-36.
Bhagvan S, Turai M, Holden A, et al. Predicting hollow viscus injury in blunt abdominal trauma with computed tomography.World J Surg 2013;37:123-6.
Matsushima K, Mangel PS, Schaefer EW, et al. Blunt hollow viscus and mesenteric injury: still underrecognized. World J Surg 2013;37(4):759-65.
Covey EH. Management of acute trauma. In: Maingot R, Zinner M, eds. Rodney Maingot’s “abdominal operations. 10th edn. Appleton & Lange 1997;6:74-78.
Malinoski DJ, Patel MS, Yakar DO, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscusinjury. J Trauma 2010;69(1):84-7.
Lee PC, Lo C, Wu JM, et al. Laparoscopy decreases the laparotomy rate in hemodynamically stable patients with blunt abdominal trauma. Surg Innov 2014;21(2):155-65.
Lin HF, Chen YD, Lin KL, et al. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries. Am J Surg 2015;210(2):326-33.
Lim KH, Chung BS, Kim JY, et al. Laparoscopic surgery in abdominal trauma: a single center review of a 7-year experience. World J Emerg Surg 2015;10(1):16.
Johnson JJ, Garwe T, Raines AR, et al. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center. Am JSurg 2013;205(3):317-20.
Koto MZ, Matsevych OY, Mosai F, et al. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg 2019;108(4):273-9.
Bansod AN, Umalkar R, Shyamkuwar AT, et al. A study of role of non-operative management in blunt abdominal trauma with solid organ injury. Int Surg J 2018;5(9):3043-50.
Wafa A, Elsagier M, Friwan R, et al. Role of Laparoscopy in Abdominal Trauma. Int J Surg Res Pract 2019;6:100.
Cirocchi R, Birindelli A, Inaba K, et al. 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):1-12.