Page 35 - World Journal of Laparoscopic Surgery

Diagnostic and Therapeutic Laparoscopy in Various Blunt Abdomen Trauma

managed conservatively by draining the hemo- Table 6: Diagnostic accuracy of laparoscopy
peritoneum with spraying of the hemolock solution Name Series No. of Diagnostic
(ferricrylum) at injury site which lead to foam formation cases Accuracy
locally and promotes hemostasis and stops minute 1. Gustavo Kuster General 140 97.9%
oozing. 2. Hamish Foster 25 General 227 89.0%
• There were two cases found with only retroperitoneum 3. Present series(2008) General 25 92%
hematoma with 100-150 cc of hemoperitoneum, but no
active bleeders found. ix. Decreased incidence of negative laparotomy: In Present
• On laparoscopy 3 patients have major injuries, one has study and study of Meyer et al the incidence of negative
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Jejunal perforation (single, small, traumatic with size of laparotomy is almost nil (Table 7). The other above mention
1 cm with healthy margin which get closed primarily in study also had average 8 to 10% of negative laparotomy,
two layers with mersilk (2-0) by simple interpreted suture. which are quite less as compared to open laparotomy study.
• One patient with intraperitoneal bladder rupture with
spillage of urine and contrast dye into the abdominal Table 7: Incidence of negative laparotomy
cavity with hemoperitoneum treated laparoscopically Sr. Name Year No. of Laparo- Lapa- No. of
by primary closure of bladder tear in two layers with no. patients scopy rotomy negative
vicryl (2-0) simple interpreted suture. laparo-
• Another case with large single traumatic perforation in tomy
ileum with large mesenteric hematoma found with 1 Cuschieri et al 24 1985 29 16 13 3 (10.3%)
moderate fecal contamination which had immediately 2 Townsend et al 22 1990 15 8 07 01 (6.6%)
converted into the exploratory laparotomy by small mid- 3 Gruppel et al 1995 118 52 45 04 (8.8%)
midline scar through the supraumblical port site. 4 Meyer et al 23 2002 20 19 01 0%
• The ileum was delivered out through small incision and 5 Present series 2008 25 24 01 0%
that necrosed segment with perforation with mesenteric x. No of port’s used: In present study we had used 3-4 ports.
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hematoma gets resected and end to end ileo ileal Most commonly 3 in number out of which 2 are of 10 mm 1
anastomosis done with thorough peritoneal lavage. is of 5 mm which is common in all cases. Umbilical port is
Almost all patients were given peritoneum lavage with usually of 10 mm. 4th trocar usually needed in complex
normal saline and drainage of peritoneal cavity done injuries to left lobe of liver, posterior pole of spleen or for
according to injury site.
• Hence in our study emergency laparoscopy has very diaphragmatic or stomach injuries for better visualization. It
is usually taken in subxiphoid/eipgastic region. YB Chol et
good diagnostic and therapeutic role in management of al series number of port used were three-umbilical port
patients with blunt abdominal injury in 96% of total (10 mm), right and left port-5 mm ,10 mm and 12 mm. 14
number. of cases. Only 4% of chances of open laparo- xi. Total duration of surgery: Average duration of surgery is
tomy in our study. There were No Missed Injury and all in minutes, approximately 45 to 50 minutes which is quite
treated patients made uneventful recovery.
• Finding of our present study are correlating with the less than for standard laparotomy which required minimum
of at least 1 hour. Hence patient had less surgical stress and
another study carried out by Pascal Fabian et al in year less postanesthetic complication. In YB Chol et al series
2000 with 81% of total patients managed by means of average duration of surgery is 142 minute. 14
laparoscopy and only 19% had conversion to open xii. No of blood transfusions: On an average amount of blood
laparotomy with no any missed injury and all patients required for any laparoscopic surgery in present study is
had uneventful recovery.
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vii. Incidence of negative laparoscopy (8%): In our present approximately 2.5 unit (1 unit = 350 cc) of whole blood on an
average is required in each patients who is hemodymically
series there are two cases in which no any visible injury found to be stable. Another study carried out by Nasr and
found in abdominal organ, but only the retroperitoneal Cynthia et al 1995 on average blood requirement is 2 units
nonexpanding hematoma which left undisturbed. Only 100- in each patient who is stable.
200 cc of hemoperitoneum was present which get drained. xiii. Failure of laparoscopy and conversion to laparotomy: In
In Pascal Fabian et al series incidence of negative our present study only in one case laparoscopy fail to
laparoscopy was 6(18.8%) cases. 19 manage injury to ileum with large traumatic perforation with
viii.Diagnostic accuracy of laparoscopy: Diagnostic accuracy mesenteric hematoma, which was managed by open mini
in our study is of 92% which is correlating with the other laparotomy with resection and anastomosis. Here only small
series (89 to 97%) (Table 6). Hence laparoscopic has got strategic incision taken through umbilical port (vertical
tremendous role in diagnosis of blunt trauma abdomen. midline incision) and traumatized part delivered out and

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