Laparoscopic management of abdominal wounds.

##plugins.themes.academic_pro.article.sidebar##

Published Apr 2, 2010
Download
pdf
Vol. 88 No. 4 (2010): Issue Apr 2010

##plugins.themes.academic_pro.article.main##

Brahim Ghariani
Hichem Houissa
Farouk Sebai

Abstract

Background : The management of abdominal wounds apart from an extreme emergency remains controversed. Means vary between explorative laparotomy and mere monitoring. Between these two extreme cases, laparoscopy as an exploration means plays a significant role, by avoiding laparotomy and by establishing the
early diagnosis of lesions.
Aim : The objective of this study is to report our experience in laparoscopic management of frontal abdominal wounds caused by a blank arm.
Patients and methods: Between January 2004 and December 2008, 61 patients with 27-year average age showing anterior abdominal wounds caused by a blank arm, with stable hemodynamic status have been subjected to a laparoscopic exploration.
Results: Laparoscopic exploration revealed a penetrating wound in 36 patients (59% of cases) of whom 27 had perforating wound. Six patients had a frontal abdominal wound, of which four have required a thoracic drainage in addition to the laparoscopic exploration of abdominal cavities. Two patients had a left diaphragmatic wound. Twelve patients (19.7%) have required a therapeutic action that consisted in an electro coagulation of filled organs, a simple suture or a resection-anastomosis for the digestive tract, and suture of diaphragmatic wounds. A conversion was performed in 7 patients (11.5%). The death rate was nul. Morbidity rate was 3.2%. Average hospitalization course was 2.54 days.
Conclusion: Laparoscopy is a safe and efficient means for exploration of abdominal cavity in patients showing a frontal abdominal wound. It allows avoiding a systematic or useless laparotomy in 88.5% of wounded individuals and then allows to trait some lesions without recours to laparotomy.

Keywords:

Abdomen, Stab wounds, , Laparoscopic

##plugins.themes.academic_pro.article.details##

References

  1. Forde KA, Ganepola GAP. Is mandatory exploration for penetrating abdominal trauma extinct? The morbidity and mortality of negative exploration in a large municipal hospital. J Trauma 1974; 14:764-6.
  2. Sirinek KR, Page CP, Root HD, et al. Is exploratory celiotomy necessary for all patients with truncal stab wounds? Arch Surg 1990; 125:844-8.
  3. Lowe RJ, Boyd DR, Folk FA, et al. The negative laparotomy for abdominal trauma. J Trauma 1972; 12:853-61.
  4. Thompson JS, Moore EE, van Duzer-Moore S, et al. The evolution of abdominal stab wound management. J Trauma 1980; 20:478-84.
  5. Demetriades D, Vandenbossche P, Ritz M, et al. Nontherapeutic operations for penetrating trauma: early morbidity and mortality. Br J Surg 1993; 80:860-1.
  6. Ertekin C, Yanar H, Taviloglu K, Guloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J. 2005 Nov; 22(11):790-4.
  7. Tsikitis V, Biffl WL, Majercik S, Harrington DT, Cioffi WG. Selective clinical management of anterior abdominal stab wounds. Am J Surg. 2004 Dec; 188(6):807-12.
  8. Ross SE, Dragon GM, O'Malley KF, Reham CG. Morbidity of negative celiotomy in trauma. Injury 1995; 26: 393-394.
  9. Renz BM, Feliciano DV. The length of hospital stay after an unnecessary laparotomy for trauma: a prospective study. J Trauma1996. 40: 187-190.
  10. Shaftan GW. Indications for operation in abdominal trauma. Am J Surg 1960; 99:657-64.
  11. Villavicencio and Aucar Laparoscopy in Trauma. J Am Coll Surg 1999; 189:11-20.
  12. Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 1987; 205:129—32.
  13. Nance FC, Wennar MH, Johnson LW, et al. Surgical judgment in the management of penetrating wounds of the abdomen: experience with 2212 patients. Ann Surg1974; 179:639—46.
  14. Robin AP, Andrews JR, Lange DA, et al. Selective management of anterior abdominal stab wounds. J Trauma 1989; 29: 1684—9.
  15. Thavendran A, Vijayaragavan A, Rasaretnam R. Selective surgery for abdominal stab wounds. Br J Surg 1975; 62: 750—2.
  16. Weigelt JA, Kingman RG. Complications of negative laparotomy for trauma. Am J Surg. 1988 ;156 :544-7
  17. Renz BM, Feliciano DV. Unnecessary laparotomies for trauma. A prospective study of morbidity. J Trauma 1995; 38: 350-356.
  18. Brefort JL, Samama G, Le Roux Y, Damamme A. Apport de la coelioscopie dans la prise en charge des plaies par arme blanche de l'abdomen. Ann Chir 1997; 51:697-702.
  19. Alves A, Panis Y, Denet C, Valleur P. Stratégie diagnostique face aux plaies de l'abdomen. Ann Chir 1998;52:927-934.
  20. Carey JE, Koo R, Miller R, Stein M. Laparotomy for trauma in a regional center: the effect of delay on outcome. Aust N Z J Surg 1994;64:484-487.
  21. Martin RR, Burch JM, Richardson R, Mattox KL. Outcome for delayed operation of penetrating colon injuries. J Trauma 1991; 31:1591—5.
  22. Gadacz T, Fabian TC, Croce MA Laparoscopy in abdominal trauma. Surg Rounds ; 1993;12:743-750
  23. Ronald J.S MD, Joseph R MD, and Deborah K MD. Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma 2002; 53:297-302.
  24. Choi YB, Lim KS. Therapeutic laparoscopy for abdominal trauma. Surg Endosc 2003; 17:421-7.
  25. Zubowski R, Nallathambi M, Ivatury R, Stahl W. Selective conservatism in abdominal stab wounds: the efficacy of serial physical examination. J Trauma 1988; 28:1665—8.
  26. Morrison JE, Wisner DH, Bodai BI.Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization. J Trauma. 1996; 41:509-13.
  27. 27.Gazzaniga AB, Stanton WW, barlett RH : Laparoscopy in the diagnosis of blunt and penetrating injuries to the abdomen.Am.J.Surg,1976:131:315-8
  28. Carnevale N, Baron N, delany HM: peritoneoscopy as an aid in the diagnosis of abdominal trauma: a preliminary report: J Trauma 1977:17:634-41
  29. Ivatury RR, Simon RJ, Stahl WM. A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma. 1993; 34:822-828.
  30. Ivatury RR, Simon RJ, Stahl WM. Selective celiotomy for missile wounds of the abdomen based on laparoscopy. Surg Endosc. 1994; 8:366-369.
  31. Madden MR, Paul DE, Finkelstein JL, et al. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma. 1989; 29:292-298.
  32. Livingston DH, Tortella BJ, Blackwood J, et al. The role of laparoscopy in abdominal trauma. J Trauma. 1992; 33:471-475.
  33. Salvino CK, Esposito TJ, Marshall WJ, et al. The role of diagnostic laparoscopy in the management of trauma patients: a preliminary assessment. J Trauma. 1993; 34:506-515.
  34. Zantut LF, Ivatury RR, Smith RS, et al. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma—a multicenter experience. J Trauma 1997; 42:825-829.
  35. Chen RJ, Fang JF, Lin BC, et al. Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma. J Trauma 1998; 44:691-695
  36. Marks JM, Youngelman DF, and Berk T. Cost analysis of diagnostic laparoscopy versus laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 1997; 11:272-276.