Page 25 - World Journal of Laparoscopic Surgery

WJOLS

Laparoscopy in Blunt Abdominal Trauma
7
8
Furthermore, Talutis et al and Borgialli et al demon- As minimal access surgery becomes more prominent,
strated the value of DL in the diagnostic workup for blunt laparoscopic surgeons should equally remain aware of
abdominal trauma in the pediatric age group. This would the potential complications that could arise when this
be of value in this age group where clinical symptoms approach is adopted in the management of patients with
9
and signs of peritonism may be equivocal. Tharakan et al blunt abdominal trauma. 21
also found that laparoscopy reliably resolves uncertainty
in hemodynamically stable pediatric patients with blunt CONCLUSION
abdominal trauma with a concerning clinical examina- Laparoscopy can be safely used both diagnostically and
tion and inconclusive imaging. They further reported that therapeutically in hemodynamically stable patients with
laparoscopy provided sensitive diagnostic capability and blunt abdominal trauma.
opportunity for definitive repair with decreased surgical
10
morbidity. Wisner et al equally included laparoscopy ACKNOWLEDGMENT
in the evaluation protocol in their large study involving
12,044 children. The author would like to acknowlege Prof RK Mishra,
In other articles, additional benefits accruing from the Dr Chowhan, The Society of Laparoscopic Surgeons,
use of DL in patients with blunt abdominal trauma are Laparoscopy for Trauma, Ransom KJ, Smith RS, Staff
11
conclusively demonstrated. Trejo-Avila et al compared of World Laparoscopy Hospital, Gurgaon, India, March
outcomes following laparoscopic vs open surgery in 2017 batch of FMAS and DMAS, World Laparoscopy
patients with abdominal trauma. They came to the con- Hospital, Gurgaon.
clusion that laparoscopic surgery for abdominal trauma
is safe and feasible in hemodynamically stable patients. REFERENCES
Furthermore, they found that laparoscopic surgery was 1. Short AR. The uses of coelioscopy. Br Med J 1925 Aug
associated with shorter operative time, lower estimated 8;2(3371):254-255.
blood loss, faster return to normal diet, and shorter hospi- 2. Stone WE. Intra-abdominal examination by the aid of the
12
tal length of stay. Lim et al had similar findings. In their peritoneoscope. J Kansas Med Soc 1924;24:63-65.
series of 111 patients with abdominal trauma, 41 were 3. Liao CH, Kuo IM, Fu CY, Chen CC, Yang SJ, Ouyang CH,
explored laparoscopically and 70 by open surgery. The Wang SY, Chen SW, Hsu YP, Kang SC. Gasless laparo-
patients who had laparoscopic surgery had less wound scopic-assisted surgery for abdominal trauma. Injury 2014
May;45(5):850-854.
infection, passed gas earlier, and had a shorter hospital 4. Choi YB, Lim KS. Therapeutic laparoscopy for abdominal
stay. Operative times were similar and neither approach trauma. Surg Endosc 2003 Mar;17(3):421-427.
was complicated by missed injury or postoperative 5. Johnson JJ, Garwe T, Raines AR, Thurman JB, Carter S,
13
intraabdominal abscesses. Khubutiya et al in a larger Bender JS, Albrecht RM. The use of laparoscopy in the diag-
study involving 628 patients equally found that compared nosis and treatment of blunt and penetrating abdominal
with patients who had open surgery, patients who had injuries: 10-year experience at a level 1 trauma center. Am J
Surg 2013 Mar;205(3):317-320.
laparoscopic surgery had quicker recovery time, less pain, 6. Lee PC, Lo C, Wu JM, Lin KL, Lin HF, Ko WJ. Laparoscopy
shorter hospital stay, and a lower complication rate. There decreases the laparotomy rate in hemodynamically stable
were no missed abdominal organ injuries at laparoscopy. patients with blunt abdominal trauma. Surg Innov 2014
Laparoscopy for abdominal trauma is useful in the Apr;21(2):155-165.
diagnosis of diaphragmatic rupture, an often missed 7. Talutis SD, Muensterer OJ, Pandya S, McBride W, Stringel G.
16
injury. 14,15 Lin et al have described a new approach for Laparoscopic-assisted management of traumatic abdominal
management of high-grade splenic injury laparoscopi- wall hernias in children: case series and a review of the
literature. J Pediatric Surg 2015 Dec;50(3):456-461.
cally. They, however, emphasize the need for adequate 8. Borgialli DA, Ellison AM, Ehrlich P, Bonsu B, Menaker J,
training on laparoscopy in trauma. Wisner DH, Atabaki S, Olsen CS, Sokolova PE, Lillis K et al.
Association between the seat belt sign and intra-abdominal
DISCUSSION injuries in children with blunt torso trauma in motor vehicle
collisions. Acad Emerg Med 2014 Nov;21(11):1240-1248.
Evaluation of diagnostic tools in blunt abdominal trauma 9. Tharakan SJ, Kim AG, Collins JL, Nance ML, Blinman TA.
remains a contemporary issue to clarify the need for Laparoscopy in pediatric abdominal trauma: A 13-Year
17
appropriate surgical intervention. This study clearly Experience. Eur J Pediatr Surg 2016 Oct;26(5):443-448.
describes the safety of DL as an approach in blunt 10. Wisner DH, Kuppermann N, Cooper A, Menaker J, Ehrlich P,
abdominal trauma. With the increasing trend for limited Kooistra J, Mahajan P, Lee L, Cook LJ, Yen K et al. Manage-
ment of children with solid organ injuries after blunt torso
intervention in appropriately selected hemodynamically trauma. J Trauma Acute Care Surg 2015 Aug;79(2):206-214.
stable patients with blunt abdominal trauma, the role of 11. Trejo-Avila ME, Valenzuela-Salazar C, Betancourt-Ferreyra J,
DL is brought to the fore. 18-20 Fernandez-Enriquez E, Romero-Loera S, Moreno-Portillo M.
World Journal of Laparoscopic Surgery, May-August 2017;10(2):66-68 67