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Fu JN, Zhou L, Ma T. The role of laparoscopy in closed abdominal injury. Heliyon 2023; 9:e20705. [PMID: 37860552 PMCID: PMC10582471 DOI: 10.1016/j.heliyon.2023.e20705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
Objective To investigate the effect of laparoscopy on the diagnosis and treatment of closed abdominal injury. Methods A total of 26 patients with closed abdominal injury admitted to our hospital from January 2016 to January 2019 were searched. All patients were treated by laparoscopy. All patient reports were made with the informed consent of the patients. Results All patients were diagnosed clearly during operation. Among them, there were 3 cases of gastric perforation, 2 cases of liver rupture, 13 cases of spleen rupture, 3 cases of small intestine rupture, 1 case of liver round ligament laceration, 2 cases of small mesenteric vascular laceration, 1 case of colon liver mesenteric laceration, and 1 case of retroperitoneal hematoma. Of the 26 patients in this group, 23 (88.5%) completed laparoscopically or laparoscopically assisted; 5 cases (19.3%) only performed laparoscopic exploration without special treatment, and 3 cases (11.5%) switched to laparotomy. The blood loss was 50-2000 ml (mean 500 ml), and the operative time was 60-180min (mean 128min). The length of hospital stay was 3-21 d (mean 9 d). There were no complications or deaths related to laparoscopy in the whole group. Conclusion Laparoscopic technique has the advantages of less trauma, high diagnosis rate and fast recovery. It can also be used for surgical treatment in the diagnosis and treatment of closed abdominal injury, so as to achieve the purpose of comprehensive diagnosis and treatment. The limitations of laparoscopy should also be noted.
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Affiliation(s)
- Jing-nan Fu
- Department of Minimally Invasive Surgery, Characteristics Medical Center of Chinese People Armed Police Force, Tianjin, China
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Zhou
- Department of nephrology, Characteristics Medical Center of Chinese People Armed Police Force, Tianjin, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Mahmoud MA, Daboos MA, Bayoumi ASS, Helal AA, Almaawi A, Hassab MH, Aldaraan KZ. Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in Children. Eur J Pediatr Surg 2021; 31:353-361. [PMID: 33757135 DOI: 10.1055/s-0041-1726411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Traditionally, exploratory laparotomy was used to treat penetrating abdominal trauma (PAT). At present, minimally invasive surgery (for diagnostic and therapeutic purposes) has developed and represents a rapidly evolving modality for dealing with PAT in stable children. In this article, we aim to present our experience, evaluate the effectiveness, and report the results of minimally invasive surgery (MIS) for PAT in stable pediatric patients. MATERIALS AND METHODS This prospective study involved 117 hemodynamically stable pediatric cases of PAT (caused by gunshots, stab, and accidental stab), admitted, and managed according to the severity of injury. The information recorded for analysis included demographic data, the anatomical location of injury, the initial vital data and scoring systems, the organs affected, the procedures done, operative time, need for conversion to laparoscopic-assisted approach, length of hospital stay, complications, missed injury, and mortality rate. RESULTS Among 117 pediatric patients with PAT, 15 cases were treated conservatively and 102 cases were managed by MIS. They were 70 males and 47 females with a mean age of 7.3 ± 0.6 years (range = 1-14 years). They included 48 cases of gunshot injury, 33 cases of abdominal stab, and 36 cases of accidental stab. Laparoscopy was diagnostic (DL) in 33.3% (n = 34) and therapeutic (TL) in 66.7% (n = 68) of cases. Of the 68 TL cases, we completely managed 59 cases (86.8%) by laparoscopy, while 9 cases (13.2%) were converted to limited laparotomy. The mean operative time was 17 ± 1 minutes (range = 12-25 minutes) for DL, 85 ± 9 minutes (range = 41-143 minutes) for complete TL cases, and 89 ± 3 minutes (range = 47-149 minutes) for laparoscopic-assisted procedures. For DL cases, the mean length of hospital stay was 2 ± 0.4 days, while for complete TL cases, it was 5.4 ± 0.83 days, and for laparoscopic-assisted cases, it was 5.8 ± 0.37 days. Postoperative complications occurred in eight cases (7.84%), with five cases (4.9%) required reintervention. No missed injury or mortality was recorded in the study. The patients were followed up for a median period of 52 months. CONCLUSION For management of PAT in children, MIS has 100% accuracy in defining the injured organs with zero percent missed injuries.
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Affiliation(s)
- Muhammad Abdelhafez Mahmoud
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mohammad Alsayed Daboos
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | | | | | - Abdulrahman Almaawi
- Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | - Mohamed Hany Hassab
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Khaled Zamel Aldaraan
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Beltzer C, Bachmann R, Strohäker J, Axt S, Schmidt R, Küper M, Königsrainer A. [Value of laparoscopy in blunt and penetrating abdominal trauma-a systematic review]. Chirurg 2020; 91:567-575. [PMID: 32193565 DOI: 10.1007/s00104-020-01158-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The range of indications for laparoscopic procedures has been continuously widened in recent years. At the same time, however, the diagnostic and therapeutic role of laparoscopy in the management of blunt and penetrating abdominal trauma remains controversial. METHODS A systematic literature search was carried out in PubMed from 2008 to 2019 on the use of laparoscopy in blunt and penetrating abdominal trauma. Studies were analyzed in terms of relevant operative and perioperative event rates (rate of missed injuries, conversion rate, postoperative complication rate). On the basis of this analysis, an algorithm for the use of laparoscopy in abdominal trauma was developed for clinical practice. RESULTS A total of 15 full texts with 5869 patients were found. With a rate of 1.4%, laparoscopically missed injuries were very rare for both penetrating and blunt abdominal trauma. Of all trauma laparoscopies 29.3% were converted to open surgery (laparotomy). Among the non-converted laparoscopies 60.5% were therapeutic. Complications occurred after trauma laparoscopy in 8.6% of cases. CONCLUSION By means of systematic laparoscopic exploration, missed injuries in abdominal trauma are extremely rare, so that concerns in this respect no longer seem justified. A large proportion of intra-abdominal injuries can be treated using laparoscopy or laparoscopically assisted procedures.
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Affiliation(s)
- Christian Beltzer
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland. .,Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Robert Bachmann
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Jens Strohäker
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Steffen Axt
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - Roland Schmidt
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Markus Küper
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland
| | - Alfred Königsrainer
- Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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Train AT, Naseem HUR, Chen Z, Wilding GE, Bass KD, Noyes K, Train WW, Rothstein DH. Predictors and Outcomes of Laparoscopy in Pediatric Trauma Patients: A Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2019; 29:1598-1604. [PMID: 31687886 DOI: 10.1089/lap.2019.0322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Laparoscopy has been shown to offer a safe alternative to laparotomy in hemodynamically stable pediatric trauma patients. Our purpose was to identify factors predictive of this approach and examine surgical outcomes. Methods: This is a retrospective cohort study using the ACS Pediatric Trauma Quality Improvement Program to examine pediatric patients who underwent exploration for blunt or penetrating abdominal trauma in 2014 and 2015. Patients with contraindications to laparoscopy were excluded. Multivariable modeling identified predictors of a laparoscopic approach. Secondary analysis assessed differences in outcomes and resource utilization between laparoscopy and laparotomy groups. Results: A total of 160 patients met inclusion criteria. Patients undergoing surgery in the northeastern (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.26-4.03, P = .006) and western (OR: 2.03, 95% CI: 1.06-3.88, P = .032) U.S. regions had over two times greater odds of undergoing laparoscopy as those treated in the south. Patients injured by a firearm were significantly less likely to undergo laparoscopy than those suffering blunt injury (OR: 0.27, 95% CI: 0.13-0.55, P < .001). After adjustment, patients explored laparoscopically in comparison with those through laparotomy had decreased average length of stay (LOS) (mean difference [MD]: 2.55 days, 95% CI: 1.19-3.90, P < .001) and number of intensive care unit (ICU) days (MD: 1.13 days, 95% CI: 0.28-1.98, P = .01). Conclusion: Trauma laparoscopy may decrease LOS and ICU days in select pediatric patients requiring abdominal exploration; however, laparoscopy is not uniformly practiced in the United States. Targeted education and protocols for initial use of laparoscopy should be incorporated into hospitals treating this group to minimize morbidity and resource utilization.
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Affiliation(s)
- Arianne T Train
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Hibbit-Ur-Rauf Naseem
- Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Ziquiang Chen
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
| | - Gregory E Wilding
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
| | - Kathryn D Bass
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Pediatric Surgery, Oishei Children's Hospital, Buffalo, New York
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York School of Public Health and Health Professions, Buffalo, New York
| | - William W Train
- Department of Surgery, Memorial Health University Medical Center, Savannah, Georgia
| | - David H Rothstein
- Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Pediatric Surgery, Oishei Children's Hospital, Buffalo, New York
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Koto MZ, Matsevych OY, Mosai F, Balabyeki M, Aldous C. Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients. J Minim Access Surg 2019; 15:25-30. [PMID: 29483377 PMCID: PMC6293668 DOI: 10.4103/jmas.jmas_199_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. Aim: The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Methods: Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Results: Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4–20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Conclusion: Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.
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Affiliation(s)
- Modise Zacharia Koto
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
| | - Oleh Y Matsevych
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria; University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
| | - Fusi Mosai
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Moses Balabyeki
- Department of Surgery, Sefako Makgatho Health Sciences University, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
| | - Colleen Aldous
- University of KwaZulu-Natal, Nelson R Mandela School of Medicine Campus, Durban, South Africa
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Bain K, Meytes V, Chang GC, Timoney MF. Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Surg Endosc 2018; 33:1618-1625. [DOI: 10.1007/s00464-018-6436-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/05/2018] [Indexed: 11/28/2022]
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Koto MZ, Matsevych OY, Aldous C. Diagnostic Laparoscopy for Trauma: How Not to Miss Injuries. J Laparoendosc Adv Surg Tech A 2018; 28:506-513. [DOI: 10.1089/lap.2017.0562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Modise Z. Koto
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu–Natal, Durban, South Africa
| | - Oleh Y. Matsevych
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu–Natal, Durban, South Africa
| | - Colleen Aldous
- Nelson R Mandela School of Medicine, University of KwaZulu–Natal, Durban, South Africa
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Matsevych O, Koto M, Balabyeki M, Aldous C. Trauma laparoscopy: when to start and when to convert? Surg Endosc 2017; 32:1344-1352. [PMID: 28799045 DOI: 10.1007/s00464-017-5812-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of laparoscopy for stable patients with abdominal trauma is increasing and its accuracy is nearly 100%. However, indications for laparoscopy and for conversion differ among centers. The aim of this study was to investigate indications for trauma laparoscopy and for conversion to laparotomy. METHODS All trauma patients managed with laparoscopy over a 4-year period were retrospectively analyzed. Indications for laparoscopy, morbidity, and reasons for conversion were investigated and predictors of morbidity and conversion were sought. The management algorithm of trauma patients was reviewed and updated. RESULTS Laparoscopy was used in 318 stable trauma patients. Thirty-five patients presented with blunt and 283 with penetrating abdominal injuries. The conversion rate was 11.7% for penetrating and 22.9% for blunt abdominal trauma patients. The most common reason for conversion was continuous intraabdominal bleeding that could not be controlled quickly. It was followed by multiple complex injuries, hemodynamic instability, and intraoperative visualization problems. Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases. There were no missed injuries. Complications occurred in 21.2% in the converted group and in 9.6% in the laparoscopic group. Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH was associated with conversion. CONCLUSION The management of all stable trauma patients with laparoscopy appears to be a safe approach. The use of sound laparoscopic equipment by a well-coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Continuous intraoperative bleeding, complexity of injuries, deterioration of the patient, poor visibility, and equipment failure are indications for conversion.
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Affiliation(s)
- Oleh Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa. .,University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa.
| | - Modise Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa.,University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
| | - Moses Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa
| | - Colleen Aldous
- University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa
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