TY - JOUR
T1 - The role of laparoscopy in management of stable patients with penetrating abdominal trauma and organ evisceration
AU - Matsevych, Oleh Y.
AU - Koto, Modise Z.
AU - Motilal, Sooraj R.
AU - Kumar, Neha
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Organ evisceration after penetrating abdominal trauma (PAT) carries a high rate of significant intra-abdominal injuries. There is uniform agreement that organ evisceration warrants immediate laparotomy. Nonoperative management of stable asymptomatic patients with evisceration is associated with a high failure rate. Most authors exclude patients with organ evisceration from laparoscopic management. The aims of this study were to determine the significance of organ evisceration in stable patientswith PATand to assess the feasibility of laparoscopic management of this group. MATERIALS AND METHODS: Intraoperative findings, performed surgery, and complications in stable patients who underwent laparoscopy for PAT and evisceration between January 2012 and December 2014 were retrospectively analyzed. All unstable patients underwent laparotomy and were excluded. RESULTS: A total of 189 stable patients were treated with laparoscopy for PAT. Thirty-nine patients (20. 6%) had organ evisceration; 37 patients had stab wounds and 2 patients had gunshot wounds. Fifteen patients had bowel evisceration and 24 had omental evisceration. In total, 25 patients (64%) had significant injuries (colon, small bowel, etc.) and required therapeutic laparoscopy. The rate of therapeutic laparoscopy was 73% in patients with bowel evisceration and 58% in patients with omental evisceration. This difference was not statistically significant. The most commonly injured organ was the small bowel. The small-bowel repair, resection, and anastomosis were the most commonly performed procedures. We did not have any missed injuries. There were neither conversions nor significant complications in the postoperative period. Fourteen patients avoided nontherapeutic laparotomy. CONCLUSION: Organ evisceration in stable patients with PAT is associated with a high rate of significant intra-abdominal injuries and mandates abdominal exploration. Laparoscopic management is feasible, has a high accuracy in identifying intraabdominal injuries, provides all benefits of minimal invasive surgery, and avoids nontherapeutic laparotomy.
AB - BACKGROUND: Organ evisceration after penetrating abdominal trauma (PAT) carries a high rate of significant intra-abdominal injuries. There is uniform agreement that organ evisceration warrants immediate laparotomy. Nonoperative management of stable asymptomatic patients with evisceration is associated with a high failure rate. Most authors exclude patients with organ evisceration from laparoscopic management. The aims of this study were to determine the significance of organ evisceration in stable patientswith PATand to assess the feasibility of laparoscopic management of this group. MATERIALS AND METHODS: Intraoperative findings, performed surgery, and complications in stable patients who underwent laparoscopy for PAT and evisceration between January 2012 and December 2014 were retrospectively analyzed. All unstable patients underwent laparotomy and were excluded. RESULTS: A total of 189 stable patients were treated with laparoscopy for PAT. Thirty-nine patients (20. 6%) had organ evisceration; 37 patients had stab wounds and 2 patients had gunshot wounds. Fifteen patients had bowel evisceration and 24 had omental evisceration. In total, 25 patients (64%) had significant injuries (colon, small bowel, etc.) and required therapeutic laparoscopy. The rate of therapeutic laparoscopy was 73% in patients with bowel evisceration and 58% in patients with omental evisceration. This difference was not statistically significant. The most commonly injured organ was the small bowel. The small-bowel repair, resection, and anastomosis were the most commonly performed procedures. We did not have any missed injuries. There were neither conversions nor significant complications in the postoperative period. Fourteen patients avoided nontherapeutic laparotomy. CONCLUSION: Organ evisceration in stable patients with PAT is associated with a high rate of significant intra-abdominal injuries and mandates abdominal exploration. Laparoscopic management is feasible, has a high accuracy in identifying intraabdominal injuries, provides all benefits of minimal invasive surgery, and avoids nontherapeutic laparotomy.
KW - Diagnostic laparoscopy
KW - Evisceration
KW - Penetrating abdominal trauma
KW - Therapeutic laparoscopy
KW - Trauma laparoscopy
UR - http://www.scopus.com/inward/record.url?scp=84962044902&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000001064
DO - 10.1097/TA.0000000000001064
M3 - Article
C2 - 27032004
AN - SCOPUS:84962044902
SN - 2163-0755
VL - 81
SP - 307
EP - 311
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -