[Laparoscopy in abdominal emergencies]

Mini-laparoscopy in blunt abdominal trauma

Blunt abdominal trauma in multiorgan injured or comatose patients always presents a problem. The aim is to assess, in the shortest period of time, which organ injury requires priority and whether intra-abdominal bleeding or perforation exists. Abdominal lavage proved to be too sensitive. Not every positive case needs exploration. Approximately 15%-20% of the cases explored because of positive lavage did not show a significant bleeding site that would require surgical treatment. The authors developed a mini-laparoscope that can be used at the bedside, in the emergency room, or in the intensive care unit. The procedure can be performed with intravenous sedation and local anesthesia. In 150 cases, no hemoperitoneum was found in 53% of these cases. Except for 1, none of these patients needed further exploration. In 21%, severe hemoperitoneum was discovered; these patients were transferred to the operating room, and this was confirmed by surgery. In 26%, a small amount of blood was found in the gutters. These patients were observed in the intensive care unit and an unnecessary exploration was avoided. Laparoscopy gives a wider range of decision making by observing the abdominal cavity. It can be completed in 10-20 min at the bedside. No serious complications were encountered. This procedure should be taught and practiced in trauma centers.

Emergency minilaparoscopy in abdominal trauma. An update

In 106 cases of blunt abdominal trauma, the emergency minilaparoscope was used as a diagnostic tool. In 57 patients (53.5 percent), the findings proved to be negative. In 22 patients (20.8 percent), the laparoscopic findings were corroborated by exploration. But, in 27 instances (25.4 percent), minimal to moderate hemoperitoneum was found and the laparoscopic view indicated that these patients could be treated nonoperatively with close observation. None of these patients required subsequent exploration. There were no complications of laparoscopy which required surgical intervention. In our opinion, minilaparoscopy is more diagnostically accurate than lavage. It is a fast and safe examination which can be performed at the bedside with the patient under local anesthesia. The number of unnecessary abdominal explorations in severely injured patients can be reduced to a negligible figure, thus decreasing morbidity, hospitalization time, and costs.

Laparoscopy in childhood

The indications and technique for laparoscopy in childhood are discussed. During the last 5 years 59 laparoscopies were carried out in the Surgical Department of the University Children's Hospital, Zürich, Switzerland, These cases are described in some detail. No complications were encountered.