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Taş İ, Yiğit E. Analysis of traumatic acute diaphragmatic injuries. Singapore Med J 2023:386390. [PMID: 37870035 DOI: 10.4103/singaporemedj.smj-2022-076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Introduction Diaphragm rupture (DR) is a rare pathological event usually caused by trauma. We aimed to analyse the characteristics of acute diaphragmatic injuries due to trauma and the treatment of such injuries. Methods This study included the data of 15 patients who sustained diaphragmatic injuries due to trauma and underwent surgery at the Diyarbakır Gazi Yaşargil Training and Research Hospital General Surgery Service between January 2016 and December 2019. Results There were 240 patients who presented with abdominal trauma during the study period, and DR was detected in 15 (6.25%) of these patients. The male to female ratio was 14 to 1, and the average age of the patients was 29.66 ± 10.56 (15-46) years. The most common cause of diaphragmatic injury was penetrating abdominal injuries (86.7%). Blunt abdominal trauma accounted for 13.3% of the DR cases. Preoperative shock was present in four (26.7%) patients. Preoperative diagnosis was made in only one (6.7%) of 15 patients with DR. Other patients were diagnosed during operation. Thirteen (86.7%) patients had additional organ injuries, and two patients had isolated diaphragmatic injuries. The most frequently injured organ was the lung (n = 7, 46.6%). Complications developed in six patients (morbidity rate 40%), and pulmonary complications were most frequently encountered (n = 5, 33.3%). The mortality rate was 6.7%. Conclusion As traumatic DRs are uncommon and often associated with additional organ injuries, a careful general assessment of the patient should be made.
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Affiliation(s)
- İlhan Taş
- Department of General Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ebral Yiğit
- Department of General Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Menegozzo CAM, Damous SHB, Sabioni GR, Alves PHF, Rasslan R, de Salles Collet E Silva F, Utiyama EM. Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases. Surg Endosc 2023; 37:6727-6735. [PMID: 37217684 DOI: 10.1007/s00464-023-10121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Trauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients. METHODS We performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann-Whitney and Kruskal-Wallis test. RESULTS We evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach. CONCLUSION In selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications.
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Affiliation(s)
- Carlos Augusto Metidieri Menegozzo
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil.
| | - Sérgio Henrique Bastos Damous
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Guilherme Rissato Sabioni
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Pedro Henrique Ferreira Alves
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Roberto Rasslan
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Francisco de Salles Collet E Silva
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil
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Diagnostic methods and surgical treatment of patients with thoracoabdominal traumas (review of the literature). KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2022; 19:226-231. [PMID: 36643345 PMCID: PMC9809188 DOI: 10.5114/kitp.2022.122093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/20/2022] [Indexed: 01/04/2023]
Abstract
Thoracoabdominal traumatism is a topical problem of modern medicine due to its wide prevalence, severe course and unfavorable outcome. This article presents an overview of the epidemiology, diagnosis, and surgical treatment of patients with thoracoabdominal injuries. It showed that the current incidence of thoracoabdominal injuries reaches 13.7-16.4% of all chest and abdominal injuries. Lethality in thoracoabdominal injuries ranges from 3.13% to 20%. In most cases these are patients of working age, with an average age of 27.5-34.8 years, men comprising 71.2%. Nowadays, the number of patients with thoracoabdominal injuries tends to increase in Uzbekistan and other economically developing countries of the world because of increasing transportation, construction and crime. Video-thoracoscopy and video-laparoscopy are among the widespread methods of diagnosis and treatment of thoracoabdominal traumas. According to many authors, the specificity of video-laparoscopy and video-thoracoscopy is 100%, and the sensitivity is 87.5-99.3%.
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Characteristics of Laparoscopic Surgery for Trauma Patients and Risks of Conversion to Open Laparotomy. World J Surg 2022; 46:2616-2624. [PMID: 36059039 DOI: 10.1007/s00268-022-06714-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The discussion is ongoing about appropriate indications for laparoscopic surgery in trauma patients. As timing and risks of conversion to laparotomy remain unclear, we aimed to elucidate characteristics of and risks for conversion following laparoscopic surgery, using a nationwide database. METHODS A retrospective observational study was conducted, using Japanese Trauma Data Bank (2004-2018). We included adult trauma patients who underwent laparoscopic surgery as an initial surgical intervention. Conversion to laparotomy was defined as laparotomy at the initial surgery. Patient demographics, mechanism and severity of injury, injured organs, timing of surgery, and clinical outcomes were compared between patients with and without conversion. Risks for conversion were analyzed focusing on indications for laparoscopic surgery, after adjusting patient and institution characteristics. RESULTS Among 444 patients eligible for the study, 31 required conversions to laparotomy. The number of laparoscopic surgeries gradually increased over the study period (0.5-4.5% of trauma laparotomy), without changes in conversion rates (5-10%). Patients who underwent conversion had more severe abdominal injuries compared with those who did not (AIS 3 vs 2). While length of hospital stay and in-hospital mortality were comparable, abdominal complications were higher among patients with conversion (12.9 vs. 2.9%), particularly when laparoscopy was performed for peritonitis (OR, 22.08 [5.11-95.39]). A generalized estimating equation model adjusted patient background and identified hemoperitoneum and peritoneal penetration as risks for conversion (OR, 24.07 [7.35-78.75] and 8.26 [1.20- 56.75], respectively). CONCLUSIONS Trauma laparoscopy for hemoperitoneum and peritoneal penetration were associated with higher incidence of conversion to open laparotomy.
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Ko J, Kong V, Amey J, Clarke D, Ah Yen D, Christey G. Surgical registrars’ exposure to trauma laparotomy: A retrospective study from a level 1 trauma centre in New Zealand. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wang J, Cheng L, Liu J, Zhang B, Wang W, Zhu W, Guo Y, Bao C, Hu Y, Qi S, Wang K, Zhao S. Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:817134. [PMID: 35350141 PMCID: PMC8957831 DOI: 10.3389/fsurg.2022.817134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
Background There is still no consensus regarding the role of laparoscopy in trauma cases. The purpose of this paper is to assess the value of diagnostic and therapeutic laparoscopy for patients with blunt or penetrating abdominal trauma by performing a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane library were systemically searched for the randomized controlled trials (RCTs) and non-RCT comparative studies on effectiveness and safety of laparoscopy vs. laparotomy for the two authors independently performed the search, data extraction, and quality assessment. Results A total of 5,517 patients were enrolled in 23 eligible studies that were published in English. Meta-analysis results suggest that there is no significant difference in the incidence of missed injury and mortality between abdominal trauma patients receiving laparoscopy and those receiving laparotomy. Concerning postoperative complications, compared with patients in the open surgery group, those in the laparoscopy group are at a similar risk of intra-abdominal abscesses, thromboembolism, and ileus, while there is a decreased incidence of wound infection and pneumonia. Besides, patients in the laparoscopy group experience shorter hospitalization times and procedure times. For most outcomes, the sensitivity analysis yielded similar results to the primary analysis. Conclusion Laparoscopic surgery is a practical alternative to laparotomy for appropriate patients. The decision to perform laparoscopy should be based on the experience of the surgeon and the resources available.
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Affiliation(s)
- Jianjun Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Liangwang Cheng
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Jing Liu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Binyin Zhang
- Department of Endocrine, Taihe People's Hospital, Fuyang, China
| | - Weijun Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Wenxin Zhu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Yan Guo
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Chuanfei Bao
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Yunli Hu
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Shanxin Qi
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Kai Wang
- Department of Emergency, Taihe People's Hospital, Fuyang, China
| | - Shuguang Zhao
- Department of Emergency, Taihe People's Hospital, Fuyang, China
- *Correspondence: Shuguang Zhao
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