Page 14 - WJOLS - Laparoscopic Journal

WJOLS

10.5005/jp-journals-10007-1109
ORIGINAL ARTICLE A Review on the Role of Laparoscopy in Abdominal Trauma
A Review on the Role of Laparoscopy in

Abdominal Trauma

Aryan Ahmed
Specialist General Surgeon, ATLS Instructor, Department of General Surgery, Hamad Medical Corporation, Doha, Qatar

ABSTRACT

Background: The trauma victims are considered the top critical patients and require a rapid decision in the management. As the main
fear is bleeding, so most of them ended having laparotomy, although almost 40% ended having a less invasive management like using
laparoscopy.
Materials and methods: The use of laparoscopy as a diagnostic (with the facility to be used as a therapeutic) option at the same setting
can be considered a very good tool provided the patient is hemodynamically stable. Classically, standard three ports (extraport can be
added according to therapeutic technique) are used. Most of the intestinal, mesenteric and diaphragmatic injuries can be detected and
repaired successfully as well as some parenchymal injuries, provided not bleeding actively and, if necessary, using some tissue
adhesives.
Results: The laparoscopic technique as a diagnostic as well as therapeutic tool (in some cases) can be used safely and with fewer
complications as it reduces the significant number of negative laparotomies.
Conclusion: An access to the abdominal cavity laparoscopically can achieve good results in hemodynamically stable patients and
avoids the morbidities related to laparotomy, decreases hospital stay and considered as a cost-effective tool.
Keywords: Abdominal trauma, Laparoscopy.

INTRODUCTION
The death rate due to trauma is increasing in the industrialized
country, whether blunt or penetrating injury. Most of the
victims are of young age groups. Most of the multiply injured
patients dies before reaching hospital because of severe
neurological or vascular injuries. Due to the increasing
experience of the surgeon, minimal access surgery has found
its way in the diagnosis as well as treatment of patients. As
the patients are considered critical, so they need a rapid
decision to be managed either surgically or conservatively.
The hemodynamically unstable patients has a less chance
of conservative approach, in reverse to that the stable one
can be managed conservatively, although this is not
applicable in all circumstances. In spite of using different
tools to diagnose injuries, sometime a great challenge will Fig. 1: Diagnostic peritoneal lavage kit
phase the treating physician but that should not make a
delay in proper management. 1

MATERIALS AND METHODS
The management of trauma patients should be through a
systematic way according to ATLS protocol which implies
a rapid and proper examination, knowing the mechanism
and severity of injury, and a concise history, if possible
which all together provides a clue to the possible injuries.
Many diagnostic tools are available for quick assessment,
like focused abdominal sonography for trauma (FAST),
diagnostic peritoneal lavage (DPL) (Figs 1 to 3) and
computerized tomography scan (CT scan). 1,3 Fig. 2: Technique of inserting DPL catheter

World Journal of Laparoscopic Surgery, January-April 2011;4(1):13-17 13