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A Comparison of Laparoscopy and Laparotomy for the Management of Abdominal Trauma: A Systematic Review and
Yueli Li1,2, Ying Xiang1,2, Na Wu1,2
1Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, 400038, People's Republic of China.
Background:
This study aimed to systematically review and compare the perioperative outcomes of laparoscopy with laparotomy for abdominal trauma patients.
Methods:
We conducted a systematic review and meta-analysis comparing the perioperative outcomes of laparoscopy with laparotomy for abdominal trauma patients. Clinical endpoints included length of hospital stay, operation time, amount of intraoperative blood loss, time to postoperative exhaust, time to regular diet, time to out of bed, duration of postoperative pain, postoperative complications, perioperative mortality rate, length of intensive care unit (ICU) stay, missed injuries, conversions to laparotomy, and cure rate.
Results:
Sixty-four studies including 9058 patients with abdominal trauma were included. In these studies, laparoscopy was used as a screening, diagnostic, or therapeutic tool. Meta-analysis showed significant reductions in the incidence of postoperative complications (relative risk [RR] [95 % confidence interval (CI)] 0.37 [0.29-0.46]), perioperative mortality rate (RR 0.64; 95 % CI 0.52-0.80), operation time (mean difference [MD] [95 % CI] -19.93 min [-34.43 to 5.43]), length of hospital stay (MD -5.15 days; 95 % CI -6.80 to 3.50), amount of intraoperative blood loss (MD -141.33 ml; 95 % CI -260.99 to 21.67), time to postoperative exhaust (MD -5.32 h; 95 % CI -8.60 to 2.05), time to regular diet (MD -3.46 h; 95 % CI -6.31 to 0.61), time to out of bed (MD -23.51 h; 95 % CI -24.85 to 22.16), duration of postoperative pain (MD -21.34 h; 95 % CI -22.65 to 20.03), length of ICU stay (MD -1.89 days; 95 % CI -4.05 to 0.27) in patients with abdominal trauma treated with laparoscopy compared with laparotomy. The pooled incidence of postoperative complications, missed injuries, conversions, and perioperative mortality rate of laparoscopy among the case reports were 0.04 (95 % CI 0.03-0.06), 0.01 (95 % CI 0.01-0.02), 0.24 (95 % CI 0.20-0.28), 0.01(95 % CI 0.01-0.02), respectively. Cure rate of laparoscopy ranged from 46 to 95 % and the pooled rate was 0.76 (95 % CI 0.71-0.81).
Conclusions:
Laparoscopy is an effective way to improve perioperative outcomes and reduce the complications of hemodynamically stable patients with abdominal trauma. It is worth further popularization in clinical practice.
