Page 36 - World Journal of Laparoscopic Surgery

VD Gohil et al
treated accordingly as mentioned above. Hence the rate of NBM and bed rest to recover from stress of abdominal open
failure of laparoscopy and conversion to open laparotomy surgery.
in our study is 4%. In Pascal et al study rate of conversion As in trauma surgery more effects toward organ preservation
to open laparotomy was 18.8%. 19 should also be made in elective/emergency laparoscopy in

xiv.Postoperative management : patient with BTA. It is found that laparoscopic partial
18
• Most of the patients kept NBM for only day 1 and started Splenectomy or same for liver lobectomy or segmentectomy is
liquids orally on 2 days. Only 4 patients kept NBM (2 for a safe method and readily mastered. If the blood vessels are
3rd POD and 2 for 4th POD) and made oral on 4th and 5th dissected carefully and in accordance with anatomical principle,
20
POD respectively. Almost 80% of patients made mobile hemisplenectomy or liver resection can be done very quickly
on 3rd POD with or without drain in situ which helpful in and with less blood loss than with open surgery. 21,9
early recovery which is main advantage of patients treated With the improvement of laparoscopic techniques and
19
laparoscopically. In study by Pascal Fabian et al patients instrumentation more blunt injuries can probably be managed
made mobile on average 4th + 1 POD. Drain removal done laparoscopically with all the benefits observed with the shift
approximately in 50% cases on 3rd POD, 36% cases on 4th from open to laparoscopic procedure, and it is likely that
POD. Most of the patients were discharge between 4th to laparoscopy will find its place as an integral part of evaluating
8th days. Mostly are on 7th day. Stitches are removed in and treating patients with blunt abdominal injury.
20
80% of patients in 7th POD while in others stitches
removed in follow up. Other study like YB Chol et al 14 CONCLUSION
mentioned mean hospital stay of 9.8 days while Pascal-
Fabian et al has mentioned 4 days of hospital stay. 19 1. Blunt injuries becoming more common than before with RTA
xv. Complication: Apparently there is no any complication are highest, Over all liver and spleen are commonly injured
found related to laparoscopic procedure in present series. solid organ, Solid organs and hollow viscera at points of
There was a one patient having persistent low SPO level fixation are more injured in blunt abdominal injuries. Serious
2
even with continuous O inhalation (6 to 8 lit. per minute) intra-abdominal injuries can occur from minor trauma.
2
which was postanesthetic complication hence not calculated 2. Highest incidence is seen in males in 2nd and 3rd decade of
in presence study. Patients referred to higher center for life.
further management. In YB Chol et al series the complication 3. Associated injury delay and mask the symptoms of blunt
had occurred only in three cases (Wound infection -1, abdominal trauma.
Paralytic ileus-1, Atelectasis -1). 14 4. Ultrasound examination plays a key role in diagnostic

xvi. Mortality and missed injury:In present study as such there armamentarium in our institute. Diagnostic Peritoneal
is no any morbidity and mortality. There is no any missed aspiration is used less in our institute. CT scan is optional
at secondary center, in developing country like India, CT
injury also found. This all findings are comparable to other scan facility is available near by trauma center. When CT
two studies (YB Chol et al and Timothy C Fabian et al). So scan is out side the hospital premises say in tertiary center
laparoscopy is quite safe and effective method. 14,15 of the developing county like India, It is dangerous to shift
The role of laparoscopy in diagnosis and management of
BTA is a topic of much debate. In this present series we have the patient having blunt abdominal injuries with
hemoperitoneum for CT scan Abdomen. In developing
reported 25 cases of BTA in which laparoscopy were used as a country the portable ultrasonography machine play a major
therapeutic tool in the management of BTA with role in management of BTA.
hemoperitoneum. In patient with spleen or liver injury, though 5. Conservative line of management for visceral trauma is to
we have CT scan or USG report, we are more comfortable only be considered whenever possible.
after seeing the organ injury by naked eye and knowing the 6. Laparoscopy is newly emerging diagnostic as well as
amount of hemoperitoneum. The other main advantage of therapeutic modality in management of blunt abdominal
laparoscopy is significantly reduced hospital stay. Patients with injury which is getting acceptance world wide, subjective
laparoscopy have very small incision with less surgical to availability of equipments and skilled team.
manipulation with early mobilization from very 3rd day in out 7. Laparoscopy provides early oral intake and early
study. Allow the patient to sent at home early as compared to mobilization of the patient which help in fast recovery and
patients who had undergone laparotomy, Hence it is helpful in early resumption of work.
terms cost effectiveness and early resumption of work. 8. Laparoscopy significantly reduces the number of negative
Laparoscopy provide patient early mobilization, oral intake laparotomies. Practically zero percent chances of negative
hence patient had good nutrition with less chance of laparotomy when patient subjected to laparoscopy.
complication to develop because of prolonged bedridden 9. In selected cases laparoscopic repair (e.g. Bowel perforation,
condition in patient of laparotomy who need at least 5 day’s Bladder rupture) can also avoid laparotomy.

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