The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Abstract

Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.

The Efficacy and Safety of Laparoscopy for Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis

“…All 19 eligible studies were single-center retrospective observational studies ( Table 1 ). Ten studies [ 7 , 9 , 10 , 11 , 12 , 15 , 18 , 19 , 20 , 23 ] comprised only BAT, and the remaining nine [ 6 , 8 , 13 , 14 , 16 , 17 , 21 , 22 , 24 ] included both BAT and PAT. All the studies were on abdominal injuries: four studies included hollow viscous organ injuries [ 9 , 10 , 11 , 23 ], two [ 12 , 19 ] included only spleen injuries, and one [ 21 ] included a non-descriptive injury.…”

“…All the studies were on abdominal injuries: four studies included hollow viscous organ injuries [ 9 , 10 , 11 , 23 ], two [ 12 , 19 ] included only spleen injuries, and one [ 21 ] included a non-descriptive injury. Five studies compared the laparoscopy and laparotomy group [ 10 , 13 , 17 , 19 , 20 ], whereas seven studies compared laparoscopy for BAT with laparoscopy for PAT [ 6 , 8 , 14 , 16 , 21 , 22 , 24 ]. Six studies that were not comparable comprised only single proportional outcomes [ 7 , 9 , 11 , 12 , 15 , 18 ].…”

“…Data from all eligible studies were extracted by two investigators. Data extracted from each eligible study include the following [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]: name of the first author, year of publication, study location, study design, study period, number of patients analyzed, age of patients, injury severity score (ISS), operation time, volume of intraoperative blood loss, rate of conversion to open laparotomy, missed injury, nontherapeutic laparotomy, duration of hospital stay, overall complications, rate of wound infection, and mortality rate. Conversion to open laparotomy was defined as laparotomy after initial laparoscopy during the same operation.…”

“…In terms of study design and anatomic location of trauma, there was substantial heterogeneity across the studies (Table 1). Fabian [6] 1993 Townsend [7] 1993 Taner [8] 2001 Mathonnet [9] 2003 Omori [10] 2003 Mitsuhide [11] 2005 Huscher [12] 2006 Kaban [13] 2008 Mallat [14] 2008 Shah [15] 2011 Johnson [16] 2013 Memon [18] 2013 Khubutiya [17] 2013 Huang [19] 2017 Koto [23] 2018 Parajuli [22] 2017 Lin [20] 2018 Matsevych [21] 2018 Nicolau [24] 2019 NOS, Newcastle-Ottawa scale; NRS, non-randomized study; , The study has met the criteria for a domain of the Newcastle-Ottawa Scale.…”

The Emergency Hospital Bucharest to the Forefront of the Emergency Laparoscopic Surgery Development

“…In the period 1995-2009, one of us (AEN) published in "Chirurgia" 4 articles about the laparoscopic suture of perforated peptic ulcer, one about the technique, and 3 articles about the utility of laparoscopy in abdominal trauma, 2 of them case presentation: ileal perforation and diaphragmatic hernia after stub wounds(4). In the period 2009-2019, there were 7 articles published in the same journal (5, [13][14][15][16][17][18][19].In total there where 42 articles about emergency laparoscopic surgery published in "Chirurgia" journal in the period 1995-2019, out of which 16 (38.09%) were written by SCUB surgeons,11 by A.E.N (4,5).We also found other six articles published in other journals (Table 1) (19)(20)(21)(22)(23)(24). Under the guidance of professor M. Beuran, the surgeons of the SCUB Surgery Clinic also had a sustained teaching activity by organising courses on the subject of emergency laparoscopic surgery during the 2008 national surgery congresses and up to now.…”