Page 33 - World Journal of Laparoscopic Surgery

Diagnostic and Therapeutic Laparoscopy in Various Blunt Abdomen Trauma

because of time consumption, need for specialized instruments the patients of blunt abdominal injury with hemoperitoneum
and need of general anesthesia (GA). As there is availability of who were relatively stable hemodynamically after adequate
sophisticated equipments, instruments and easy availability of resuscitation taken into study and treated as per the standard
anesthetists, laparoscopy is being used more and more for protocol of laparoscopic management after investigated
diagnosis as well as therapeutic measure in BTA. 4 thoroughly.
Laparoscopy was first used for a trauma patient in1956 by
Lamy, who observed two cases of splenic injury. Since then, CONTRAINDICATION TO LAPAROSCOPY IN
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Gazzaniga et al. noted that laparoscopy is useful for determining PATIENT WITH BTA 13
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the need for laparotomy. In 1991, Berci et al. reported that he 1. BTA with associated head injury with EDH/SDH (GC scale
had reduced the number of nontherapeutic laparotomy < 13 -15)
performed for hemoperitoneum by 25% through the use of 2. BTA with polytrauma (compound fracture, spine fracture,
laparoscopy in 150 patients with blunt abdominal trauma. Chol severe chest injury with SPO < 90%)
2
et al reported reduced negative and nontherapeutic laparotomy 3. BTA with hemodynamic instability
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rates in this identified population. Hemoperitoneum associated 4. BTA with difficulty in endotracheal intubation.
with stable vitals with liver injury, splenic injury, bowel injury, 5. Pregnancy
mesenteric injury, or bladder injury can be managed very well Patients were given general anesthesia and supine position.
by means of laparoscopy. Advanced laparoscopic technique First trocar inserted at supraumblical ridge with open Hassan’s
including bowel resection and anastomosis, ligation of blood method with pneumoperitoneum with pressure of 12-15 mm Hg.
vessels can be utilized in BTA, as good as in elective open Other port site created under direct vision from within. The
surgery. 8-11 One can visualize peritoneal cavity and act standard three main ports are (a) umbilical port (10 mm) (b) right
expeditiously if needed (i.e. laparotomy, laparoscopic assisted sided port (5 mm /10 mm) (c) Left sided port (5 mm/10 mm) (d)
intervention or only observation) at time of laparoscopy. 12 others: Extra port made according to organ injury and difficulty
Laparoscopy is cost effective, reduces the rate of negative in its management usually, subxiphoid 5 mm in epigastrium and
laparotomy, reduces the patient’s stay in hospital and mortality in lower abdomen in case of pelvic organ injury.
and allows early mobilization and resumption of work. Diagnostic laparoscopy was done through out the all
However with advancement in techniques and equipments, quadrant from splenic fossa to liver as clock vise. All small
it ‘MAY’ happen so that laparoscopy may replace laparotomy bowel and large bowel are thoroughly checked by walk over.
in near coming future. Lesser sac and duodenum are checked and lastly
retroperitoneum was explored. Blood was aspirated and suction
AIMS AND OBJECTIVES
and irrigation done.
1. To know the mode of injury and incidence of organ In our prospective study, we have done therapeutic
involvement in blunt trauma abdomen in developing laparoscopy by laparoscopic primary closure of the jejunal
country. perforation, primary repair of bladder rupture in two layer, and
2. To study the management of blunt trauma abdomen in electro cauterization and hemolock solution spraying locally at
tertiary center in developing countries like India. liver or splenic injury (either contusion, laceration or tear) with
3. To find out the role of laparoscopy (diagnostic as well as no active bleeding without disturbing the preformed hematoma.
therapeutic) in management of blunt trauma abdomen (BTA). All patients were kept under observation in CCU and then after
4. To reduce the incidence of negative laparotomy. shift to the ward as they were stabilized postoperatively. Due
5. To find out the limitation of laparoscopy in blunt trauma postoperative care given and good follow-up done for every
abdomen. patients. Our results are as below.
6. To review the method of patient selection, operative
technique, operating time, intraoperative and postoperative OBSERVATION AND DISCUSSION
complications. In present series total 25 cases of blunt abdominal trauma were
7. To find out the impact of laparoscopy on patient with blunt studied. All have gone through the emergency exploratory
trauma abdomen in terms of early rehabilitation, cost laparoscopy, out of which 24 cases (96%) managed laparo-
effectiveness and decreased hospital stay and lastly scopically and only 1 case (4%) converted into open exploratory
cosmesis.
laparotomy.
i. Indication for laparoscopy: 13,17
MATERIAL AND METHODS
• Hemodynamically stable.
To know the role of laparoscopy in the blunt abdominal injury, • Some abdominal injury.
we have carried out a prospective study among the patients of • DPA (Diagnostic peritoneal aspiration) positive.
surgical wards of Sir T hospital, Bhavnagar, Gujarat, India. All • USG/FAST–positive.

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