Systematized Laparoscopic Surgery in Abdominal Trauma

Choi, Gyu Seog

Abstract

With the wide spread of laparoscopic procedures in surgery, laparoscopy has been revived as a diagnostic and therapeutic modality in blunt and penetrating abdominal trauma. From August 1995 to November 1996, we applied therapeutic laparoscopy to 15 hemodynamically stable patients with abdominal trauma, including 10 (66%) blunt and 5 (34%) penetrating injuries. The mean age of the patients was 35 (17~64) years. All were male, except for one female patient. Organs injured were 4 single perforations, 1 multiple perforation and 1 complete transsection of the small bowel; 2 mesenteric tearings with small bowel ischemia; 2 stomach perforations; 2 mesenteric lacerations; 2 omental lacerations; and 1 liver laceration. Patients with unstable vital signs, or solid organ or retroperitoneal injury were excluded by conventional diagnoses. Laparoscopic abdominal exploration was initiated by changing the position to the Trendelenburg position for evaluation of the pelvic cavity and lower-1/3 of the small bowel, to the supine position for evaluation of the mid-abdomen and mid-1/3 of the small bowel, and to the reverse Trendelenburg for evaluation of the liver, spleen, pancreas, and upper 1/3 of the small bowel. Operation methods consisted of totally laparoscopic or laparoscopic-assisted techniques in 11 cases (73.3%) and 4 cases (26.7%), respectively. Hence, we were able to reduce the rate of open surgery in 11 (73.3%) of the 15 patients who were thought to need operative treatment, 14 of whom needed actual surgical intervention (One pre-operatively undetected liver laceration revealed spontaneous ceasation of bleeding at the time of laparoscopic examination). The mean operation time was 110 min per case (113 min and 100 min for totally laparoscopic surgery and laparoscopic-assisted surgery, respectively). Flatus passed at the 2.4 (mean) post-operative day. The patients started meals at the 3.3 (mean) post-operative day and were discharged at the 7 (mean) post-operative day uneventfully. The only exception was one wound infection in the laparoscopic-assisted group. Conclusively, sytematized laparoscopic surgery is a feasible, safe, and effective procedure for the treatment of abdominal trauma.