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The Role of Laparoscopy in Penetrating Abdominal Trauma

BACKGROUND: Minimally invasive surgery has become increasingly utilized in the trauma setting. When properly applied, it offers several advantages, including reduced morbidity, lower rates of negative laparotomy, and shortened length of hospital stay. The purpose of this study was to evaluate the ro...

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Autores principales: Miles, Erik J., Dunn, Ernest, Howard, Dot, Mangram, Alicia
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2004
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016820/
https://www.ncbi.nlm.nih.gov/pubmed/15554270
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author Miles, Erik J.
Dunn, Ernest
Howard, Dot
Mangram, Alicia
author_facet Miles, Erik J.
Dunn, Ernest
Howard, Dot
Mangram, Alicia
author_sort Miles, Erik J.
collection PubMed
description BACKGROUND: Minimally invasive surgery has become increasingly utilized in the trauma setting. When properly applied, it offers several advantages, including reduced morbidity, lower rates of negative laparotomy, and shortened length of hospital stay. The purpose of this study was to evaluate the role of laparoscopy in the management of trauma patients with penetrating abdominal injuries. METHODS: We conducted a 3-year retrospective chart review of 4541 trauma patients admitted to our urban Level II trauma center. Penetrating abdominal injuries accounted for 209 of these admissions. Patients were divided into 3 treatment groups based on the characteristics of their abdominal injuries. Management was either observation, immediate laparotomy, or screening laparoscopy. RESULTS: Thirty-three patients were observed in the Emergency Department based on their initial physical examination and radiologic studies. After Emergency Department evaluation, 154 patients underwent immediate laparotomy. In this group, 119 therapeutic laparotomies, 11 nontherapeutic laparotomies, and 24 negative laparotomies were performed. A review of the negative laparotomies revealed that possibly 8 of 10 gun shot wounds and all 14 stab wounds could have been done laparoscopically. Twenty-two patients underwent laparoscopic evaluation, 9 of which were converted to open procedures. CONCLUSION: Minimally invasive surgical techniques are particularly helpful as a screening tool for anterior abdominal wall wounds and lower chest injuries to rule out peritoneal penetration. Increased use of laparoscopy in select patients with penetrating abdominal trauma will decrease the rate of negative and nontherapeutic laparotomies, thus lowering morbidity and decreasing length of hospitalization. As technology and expertise among surgeons continues to improve, more therapeutic intervention may be done laparoscopically in the future.
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spelling pubmed-30168202011-02-17 The Role of Laparoscopy in Penetrating Abdominal Trauma Miles, Erik J. Dunn, Ernest Howard, Dot Mangram, Alicia JSLS Scientific Papers BACKGROUND: Minimally invasive surgery has become increasingly utilized in the trauma setting. When properly applied, it offers several advantages, including reduced morbidity, lower rates of negative laparotomy, and shortened length of hospital stay. The purpose of this study was to evaluate the role of laparoscopy in the management of trauma patients with penetrating abdominal injuries. METHODS: We conducted a 3-year retrospective chart review of 4541 trauma patients admitted to our urban Level II trauma center. Penetrating abdominal injuries accounted for 209 of these admissions. Patients were divided into 3 treatment groups based on the characteristics of their abdominal injuries. Management was either observation, immediate laparotomy, or screening laparoscopy. RESULTS: Thirty-three patients were observed in the Emergency Department based on their initial physical examination and radiologic studies. After Emergency Department evaluation, 154 patients underwent immediate laparotomy. In this group, 119 therapeutic laparotomies, 11 nontherapeutic laparotomies, and 24 negative laparotomies were performed. A review of the negative laparotomies revealed that possibly 8 of 10 gun shot wounds and all 14 stab wounds could have been done laparoscopically. Twenty-two patients underwent laparoscopic evaluation, 9 of which were converted to open procedures. CONCLUSION: Minimally invasive surgical techniques are particularly helpful as a screening tool for anterior abdominal wall wounds and lower chest injuries to rule out peritoneal penetration. Increased use of laparoscopy in select patients with penetrating abdominal trauma will decrease the rate of negative and nontherapeutic laparotomies, thus lowering morbidity and decreasing length of hospitalization. As technology and expertise among surgeons continues to improve, more therapeutic intervention may be done laparoscopically in the future. Society of Laparoendoscopic Surgeons 2004 /pmc/articles/PMC3016820/ /pubmed/15554270 Text en © 2004 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Miles, Erik J.
Dunn, Ernest
Howard, Dot
Mangram, Alicia
The Role of Laparoscopy in Penetrating Abdominal Trauma
title The Role of Laparoscopy in Penetrating Abdominal Trauma
title_full The Role of Laparoscopy in Penetrating Abdominal Trauma
title_fullStr The Role of Laparoscopy in Penetrating Abdominal Trauma
title_full_unstemmed The Role of Laparoscopy in Penetrating Abdominal Trauma
title_short The Role of Laparoscopy in Penetrating Abdominal Trauma
title_sort role of laparoscopy in penetrating abdominal trauma
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016820/
https://www.ncbi.nlm.nih.gov/pubmed/15554270
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