Page 32 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):42-47
VD Gohil et al

Diagnostic and Therapeutic Laparoscopy in

Various Blunt Abdomen Trauma

1 2 3
VD Gohil, HD Palekar, M Ghoghari
1 Assistant Professor, Department of Surgery, Government Medical College and Sir Takhtasinhaji Hospital, Bhavnagar
Gujarat, India
2 Associate Professor, Department of Surgery, Government Medical College and Sir Takhtasinhaji Hospital, Bhavnagar
Gujarat, India
3 Resident, Department of Surgery, Government Medical College and Sir Takhtasinhaji Hospital, Bhavnagar, Gujarat, India

Correspondence: VD Gohil, Assistant Professor, Department of Surgery, Government Medical College and
Sir Takhtasinhaji Hospital, C/173, Gaytrikrupa, Kalvibid, Ramnagar, Bhavnagar, Gujarat, India, Mob: 9825607560
E-mail: drvijayrajgohil@gmail.com

Abstract Keywords: Diagnostic and therapeutic laparoscopy, blunt abdomen
The abdomen is the “Black box” i.e., it is impossible to know what trauma, minimal access surgery, exploratory laparotomy.
specific injuries have occurred at initial evaluation. The key to saving
lives in abdominal trauma is NOT to make an accurate diagnosis, but INTRODUCTION
rather to recognize that there is an abdominal injury. Minimal-access In the environment that human being has created exposes him

surgery is an integral component of the alternative surgerymanagement to variety of injuries caused by numerous forces like vehicular

paradigm. The addition of videoscopic technology to intracavitary

endoscopy has led to a tremendous expansion of indications for accident, social conflict, crimes, terrorism, wars, industrial
minimal-access procedures in all fields of surgery. The use of accident, fall from height. In this situation the incidents of blunt

laparoscopy to assess the peritoneal cavity for injury is not a new abdominal injuries has also been increasing with other injuries

concept. Reports by Tostivint et al, Gazzaniga et al, and Carnevale et of the body part being injured. Road traffic accidents (RTA) are

al discussed the possibilities of using this minimally invasive approach a major cause of blunt abdominal injuries nowaday responsible

to evaluate the peritoneal cavity for injuries. Laparoscopy has become for 45 to 50% of BATs. Assaults, falls, automobile–pedestrian
1

an important diagnostic and therapeutic tool in the treatment of both accidents and work-related injuries are also common. 2

blunt and penetrating traumatic injuries. Laparoscopy has been shown Abdominal injuries in blunt trauma result from compression,

to be valuable in detecting occult diaphragmatic injuries in locations

where computed tomography (CT) scanning and diagnostic peritoneal crushing, shearing, or deceleration mechanisms. Fortunately,

lavage have recognized limitations. Notably, laparoscopy can also the incidence of BAT requiring laparotomy is only 6%. The

provide therapeutic interventions in certain circumstances as well. most frequently injured organs are the spleen (40 to 55%), the

Simultaneous gastric and diaphragmatic injuries have been repaired liver (35 to 45%), and the retroperitoneum (15%). 3

using this approach. Laparoscopy has been used to repair blunt Management of blunt trauma abdomen (BTA) requires an

traumatic solid organ injuries, including a subcapsular splenic art of resuscitation early diagnosis and initial evaluation and

hematoma. Blunt hepatic injuries have been successfully treated management then lastly the perfect surgical skill. In blunt trauma

laparoscopicallywith the instillation of fibrin glue. A duodenal hematoma abdomen most commonly injured organs are liver, spleen,
has been decompressed laparoscopically. Importantly, in trauma
patients with potential intracranial injuries, laparoscopy should be used kidney, intestines, pancreas, stomach, urinary bladder and
1,3
cautiously because of the risk of increased intracranial pressure. vessels accordingly. Previously all BTA ended up in

Laparoscopy is also potentially hazardous in patients with acute laparotomy and managed according to organ injury, however

respiratory distress syndrome, because lung compliance and effective in such cases chances of negative laparotomy were high but,
gas exchange may be further decreased by the pneumoperitoneum. due to research and advances in diagnostic field like USG, DPL,
Laparoscopy can be performed safely and effectively in stable patients CT-scan abdomen the chances of negative laparotomy
with abdominal trauma. The most important advantages are reduction significantly reduced and sometimes managed conservatively. 16
of morbidity, shortening of hospitalization and cost effectiveness. In With advent and development of new technology,
the future, new development in laparoscopy equipment and the
introduction of computer technology and robotic devices can be laparoscopy-minimally access surgery (MAS) has diagnostic
expected to have a decisive influence on the treatment of trauma as well as definitive therapeutic role in blunt trauma abdomen
4
patients. (BTA). In the past it was limited only as diagnostic procedure
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