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.
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.
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