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Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose?
BACKGROUND: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asympt...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438062/ https://www.ncbi.nlm.nih.gov/pubmed/30178773 http://dx.doi.org/10.4103/jmas.JMAS_72_18 |
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author | Matsevych, Oleh Yevhenovych Koto, Modise Zacharia Balabyeki, Moses Mashego, Lehlogonolo David Aldous, Colleen |
author_facet | Matsevych, Oleh Yevhenovych Koto, Modise Zacharia Balabyeki, Moses Mashego, Lehlogonolo David Aldous, Colleen |
author_sort | Matsevych, Oleh Yevhenovych |
collection | PubMed |
description | BACKGROUND: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL. METHODS: Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes. RESULTS: Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality. CONCLUSION: NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies. |
format | Online Article Text |
id | pubmed-6438062 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-64380622019-04-13 Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? Matsevych, Oleh Yevhenovych Koto, Modise Zacharia Balabyeki, Moses Mashego, Lehlogonolo David Aldous, Colleen J Minim Access Surg Original Article BACKGROUND: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL. METHODS: Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes. RESULTS: Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality. CONCLUSION: NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies. Medknow Publications & Media Pvt Ltd 2019 /pmc/articles/PMC6438062/ /pubmed/30178773 http://dx.doi.org/10.4103/jmas.JMAS_72_18 Text en Copyright: © 2018 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Matsevych, Oleh Yevhenovych Koto, Modise Zacharia Balabyeki, Moses Mashego, Lehlogonolo David Aldous, Colleen Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title_full | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title_fullStr | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title_full_unstemmed | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title_short | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
title_sort | diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: what to choose? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438062/ https://www.ncbi.nlm.nih.gov/pubmed/30178773 http://dx.doi.org/10.4103/jmas.JMAS_72_18 |
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