Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 9 , ISSUE 1 ( January-April, 2020 ) > List of Articles


Minimally Invasive Surgery in the Management of Blunt and Penetrating Abdominal Injuries: Two-decade Experience from a Brazilian Trauma Center

Carlos EB da Cunha, Mariana K Fonseca, Mauro de Souza Siebert Junior, Ricardo Breigeiron, Miguel P Nacul

Keywords : Blunt abdominal trauma, Laparoscopy, Penetrating abdominal injury, Trauma

Citation Information : da Cunha CE, Fonseca MK, Siebert Junior MD, Breigeiron R, Nacul MP. Minimally Invasive Surgery in the Management of Blunt and Penetrating Abdominal Injuries: Two-decade Experience from a Brazilian Trauma Center. Panam J Trauma Crit Care Emerg Surg 2020; 9 (1):74-80.

DOI: 10.5005/jp-journals-10030-1268

License: CC BY-NC 4.0

Published Online: 25-04-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Minimally invasive surgery (MIS) is becoming widely accepted as a useful diagnostic and therapeutic modality in acute trauma management. This study aims to describe the experience of a Brazilian trauma center with laparoscopic procedures for the management of abdominal trauma over a two-decade period. Materials and methods: A retrospective analysis was conducted on all patients undergoing laparoscopy following blunt and penetrating abdominal trauma and admitted to a single trauma center from October 1997 to January 2019. Data on subjects’ demographics, baseline presentations, diagnostic and therapeutic laparoscopic procedures performed, and outcomes were reported. Results: Laparoscopic surgical exploration was performed on 225 patients presenting with abdominal trauma during the study period, including 28 (12.4%) patients sustaining blunt and 197 (87.6%) penetrating injuries, primarily stab wounds (68%; n = 153). The mean age was 30.2 ± 12.9 years (range 7–81) and the majority accounted for males (84%; n = 189). Negative laparoscopy and nontherapeutic procedures were recorded in 71 (31.5%) and 34 (15%) cases, respectively. After positive findings in diagnostic laparoscopic, 55 (24.4%) patients underwent exclusive minimally invasive repair and the remaining 65 cases (28.8%) required conversion to open surgery, thus avoiding 160 unnecessary laparotomies. No missed injuries were reported. The overall morbidity rate was 8.4%, with only 1.7% of complications being classified as severe, including two demises. Conclusion: Diagnostic and therapeutic laparoscopy are an appropriate management in selected patients sustaining both blunt or penetrating abdominal trauma, with potentially improved outcomes compared with traditional approaches. Further research shall provide quality evidence for the establishment of standardized protocols to guide indications and limits of this technique in trauma practice.

  1. Uranus S, Dorr K. Laparoscopy in abdominal trauma. Eur J Trauma Emerg Surg 2010;36(1):19–24. DOI: 10.1007/s00068-010-9219-5.
  2. Ball CG, Karmali S, Rajani RR. Laparoscopy in trauma: an evolution in progress. Injury. 2009;40(1):7–10. DOI: 10.1016/j.injury.2008.09.005.
  3. Grushka J, Ginzburg E. Through the 10-mm looking glass: advances in minimally invasive surgery in trauma. Scand J Surg 2014;103(2): 143–148. DOI: 10.1177/1457496914523414.
  4. Wiewióra M, Sosada K, Piecuch J, et al. The role of laparoscopy in abdominal trauma – review in literature. Wideochir Inne Tech Maloinwazyjne 2011;6(3):121–126. DOI: 10.5114/wiitm.2011. 24688.
  5. Mandrioli M, Inaba K, Piccinini A, et al. Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol 2016;22(2): 668–680. DOI: 10.3748/wjg.v22.i2.668.
  6. Coleman L, Gilna G, Portenier D, et al. Trauma laparoscopy from 1925 to 2017: publication history and study demographics of an evolving modality. J Trauma Acute Care Surg 2018;84(4):664–669. DOI: 10.1097/TA.0000000000001780.
  7. Stringel G, Xu ML, Lopez J. Minimally invasive surgery in pediatric trauma: One institution's 20-year experience. JSLS. 2016;20(1):e2015.00111. DOI: 10.4293/JSLS.2015.00111.
  8. Di Saverio S. Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg 2014;77(2):338–350. DOI: 10.1097/TA.0000000000000288.
  9. Zafar SN, Onwugbufor MT, Hughes K, et al. Laparoscopic surgery for trauma: the realm of therapeutic management. Am J Surg 2015;209(4):627–632. DOI: 10.1016/j.amjsurg.2014.12.011.
  10. Antoniou SA, Antoniou GA, Antoniou AI, et al. Past, present, and future of minimally invasive abdominal surgery. JSLS. 2015;19(3):e2015.00052. DOI: 10.4293/JSLS.2015.00052.
  11. Agresta F, De Simone P, Bedin N. The laparoscopic approach in abdominal emergencies: a single-center 10-year experience. JSLS. 2004;8(1):25–30.
  12. McCrory B, LaGrange CA, Hallbeck M. Quality and safety of minimally invasive surgery: past, present, and future. Biomed Eng Comput Biol 2014;6:1–11. DOI: 10.4137/BECB.S10967.
  13. Li Y, Xiang Y, Wu N, et al. A comparison of laparoscopy and laparotomy for the management of abdominal trauma: a systematic review and meta-analysis. World J Surg 2015;39(12):2862–2871. DOI: 10.1007/s00268-015-3212-4.
  14. Mack MJ. Minimally invasive and robotic surgery. JAMA 2001;285(5):568–572. DOI: 10.1001/jama.285.5.568.
  15. Hajibandeh S, Hajibandeh S, Gumber AO, et al. Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: a systematic review and meta-analysis. Int J Surg 2016;34:127–136. DOI: 10.1016/j.ijsu.2016.08.524.
  16. Lee PC, Lo C, Wu JM, et al. Laparoscopy decreases the laparotomy rate in hemodynamically stable patients with blunt abdominal trauma. Surg Innov. 2014;21(2):155–165. DOI: 10.1177/1553350612474496.
  17. Pearson EG, Clifton MS. The role of minimally invasive surgery in pediatric trauma. Surg Clin North Am 2017;97(1):75–84. DOI: 10.1016/j.suc.2016.08.005.
  18. Uranues S, Popa DE, Diaconescu B, et al. Laparoscopy in penetrating abdominal trauma. World J Surg 2015;39(6):1381–1388. DOI: 10.1007/s00268-014-2904-5.
  19. Matsevych O, Koto M, Balabyeki M, et al. Trauma laparoscopy: When to start and when to convert? Surg Endosc. 2018;32(3):1344–1352. DOI: 10.1007/s00464-017-5812-6.
  20. Johnson JJ, Garwe T, Raines AR, et al. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center. Am J Surg 2013;205(3):317–320. DOI: 10.1016/j.amjsurg.2012.10.021.
  21. Kawahara NT, Alster C, Fujimura I, et al. Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma. 2009;67(3):589–595. DOI: 10.1097/TA.0b013e3181a60593.
  22. Lim KH, Chung BS, Kim JY, et al. Laparoscopic surgery in abdominal trauma: a single center review of a 7-year experience. World J Emerg Surg 2015;10(1):16. DOI: 10.1186/s13017-015-0007-8.
  23. Nácul MP, Velho AV, Nimer NY, et al. Videolaparoscopia no trauma abdominal contuso. Ver Bras Videocir 2005;3(4):196–207.
  24. Chestovich PJ, Browder TD, Morrissey SL, et al. Minimally invasive is maximally effective: diagnostic and therapeutic laparoscopy for penetrating abdominal injuries. J Trauma Acute Care Surg 2015;78(6):1076–1083. DOI: 10.1097/TA.0000000000000655.
  25. Koto MZ, Matsevych OY, Aldous C. Diagnostic laparoscopy for trauma: How not to miss injuries. J Laparoendosc Adv Surg Tech 2018;28(5):506–513. DOI: 10.1089/lap.2017.0562.
  26. Matsevych OY, Koto MZ, Aldous C. Trauma laparoscopy: a prospect of skills training (cohort study). Int J Surg 2018;55:117–123. DOI: 10.1016/j.ijsu.2018.05.033.
  27. Chol YB, Lim KS. Therapeutic laparoscopy for abdominal trauma. Surg Endosc. 2003;17(3):421–427. DOI: 10.1007/s00464-002- 8808-8.
  28. Cirocchi R, Birindelli A, Inaba K, et al. Laparoscopy for trauma and the changes in its use from 1990 to 2016: a current systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2018;28(1):1–12. DOI: 10.1097/SLE.0000000000000466.
  29. Justin V, Fingerhut A, Uranues S. Laparoscopy in blunt abdominal trauma: for whom? when? and why? Curr Trauma Rep 2017;3(1):43–50. DOI: 10.1007/s40719-017-0076-0.
  30. Breigeiron R, Breitenbach TC, Zanini LAG, et al. Comparison between isolated serial clinical examination and computed tomography for stab wounds in the anterior abdominal wall. Rev Col Bras Cir 2017;44(6):596–602. DOI: 10.1590/0100-69912017006009.
  31. Starling SV, Rodrigues BL, Martins MPR, et al. Non operative management of gunshot wounds on the right thoracoabdomen. Rev Col Bras Cir 2012;39(4):286–294. DOI: 10.1590/s0100-69912012000400008.
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