Page 24 - World Journal of Laparoscopic Surgery

WJOLS

Michael Ikechukwu Nnamonu 10.5005/jp-journals-10033-1306
RevieW ARticLe

Laparoscopy in Blunt Abdominal Trauma

Michael Ikechukwu Nnamonu

ABSTRACT preclude laparoscopy. The gasless laparoscopy technique

Introduction: This review describes the role of laparoscopy has been described to attenuate this as well as to prevent
in patients with blunt abdominal trauma. air embolism and also pneumothorax in patients with
occult diaphragmatic injuries. 3
Materials and methods: Keywords, such as laparoscopy,
blunt, abdominal, trauma were entered into PubMed search Laparoscopy can be safely used when an intraabdomi-
engine and filtered for peer-reviewed articles written in the nal injury is suspected in a patient, i.e., hemodynamically
last 5 years. stable. These are patients with a systolic blood pressure
Results and discussion: The findings from these articles are of >100 mm Hg, diastolic blood pressure of >60 mm Hg,
collated and discussed. a heart rate of <110 beats per minute, and crystalloid
Conclusion: Laparoscopy is a safe approach both for diagnosis resuscitation requirements of <2 L. 4
and treatment of patients with blunt abdominal trauma and is The objective of this review is to determine the scope
associated with the benefits of laparoscopic approach. of the diagnostic and therapeutic uses of laparoscopy in
Keywords: Blunt abdominal trauma, Diagnostic laparoscopy, blunt abdominal trauma, and also to delineate the ben-
Missed visceral injuries, Therapeutic laparoscopy. efits, complications, as well as prospects of laparoscopy
How to cite this article: Nnamonu MI. Laparoscopy in Blunt in patients with blunt abdominal trauma.
Abdominal Trauma. World J Lap Surg 2017;10(2):66-68.
Source of support: Nil MATERIALS AND METHODS
Conflict of interest: None The PubMed search engine was used to search for
peer-reviewed articles. The keywords entered were
laparoscopy, blunt, abdominal, and trauma. The search
INTRODUCTION
was filtered to include only articles written in the last
The use of laparoscopy in trauma has lagged behind in 5 years. All 55 articles obtained from the database were
the otherwise rapid progression of this groundbreaking then reviewed for relevance and sample size. Case reports
surgical tool. Although reports exist of the use of lapa- were excluded.
roscopy for the diagnosis of hemoperitoneum as far back
as the 1920s, there is still a paucity of literature on this RESULTS
subject to this day. 1,2
There is no doubt that this is related to the nature of Several articles discussed the uses of laparoscopy in blunt
trauma. There is often anxiety and concern to optimize abdominal trauma. The role of laparoscopy as the most
the patient with the quickest possible intervention. It sensitive detector of a breach of the peritoneum in pen-
5
should be stated early in this discourse that there is no etrating abdominal trauma is immediately apparent. It
role for laparoscopy in the management of the patient is instructive that the authors reviewed equally acknowl-
with abdominal trauma who is hemodynamically unsta- edged the role of laparoscopy in diagnosis in blunt
5
ble. The priority in this situation follows the standard abdominal trauma. Johnson et al started their study on
life-saving principles of resuscitation, with quick access the established premise that diagnostic laparoscopy (DL)
for hemostasis, which must in those situations be open had decreased the rate of nontherapeutic laparotomies in
surgery. Associated extraabdominal injuries like head patients with penetrating abdominal injuries. They sort to
injuries may also be worsened by the hemodynamic determine whether DL similarly lowered nontherapeutic
effects of carbon dioxide pneumoperitoneum and may laparotomy in blunt abdominal injury. They found that
coupled with diagnostic computed tomography (CT)
scan, DL yielded a nontherapeutic laparotomy rate of 0%
Surgeon in patients with blunt abdominal trauma. They concluded
Department of Surgery, NLNG Industrial Hospital, Bonny, Rivers that when combined with CT scan, DL is a useful tool
State, Nigeria in the initial evaluation of patients with blunt abdomi-
6
Corresponding Author: Michael Ikechukwu Nnamonu, Surgeon nal trauma. Lee et al had similar findings demonstrating
Department of Surgery, NLNG Industrial Hospital, Bonny, Rivers that the use of laparoscopy in patients with abdominal
State, Nigeria, e-mail: miknnamonu@yahoo.com
trauma safely decreased the laparotomy rate.
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