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Published on: December 4, 2023
Safety and effectiveness of laparoscopy in patients with blunt abdominal trauma: a 12-year experience in a reference
Sérgio Henrique Bastos Damous1, Eric Arcanjo Brignel1, Carlos Augusto Metidieri Menegozzo1
1- Hospital das Clínicas da Faculdade de Medicina de São Paulo (HCFMUSP), Divisão de Clínica Cirúrgica III - Departamento de Cirurgia - São Paulo - SP - Brasil.
Background:
The benefit of laparoscopy in blunt abdominal trauma (BAT) remains debated. This study analyzed patients with BAT treated by laparoscopy in a tertiary reference trauma service in Brazil.
Methods:
A retrospective clinical study of hemodynamically stable patients with BAT treated by laparoscopy over a 12-year period was conducted. Laparoscopies were classified as diagnostic (DL) or therapeutic (TL).
Results:
Over a 12-year period, 85 patients with BAT were treated laparoscopically. The median age was 30 years, and most patients were male (80%) and had an ASA of I (72%). Collision was the most frequent mechanism (46%). The main indications for laparoscopy were the presence of free fluid without parenchymal lesions on CT (59%) and abdominal pain/signs of peritoneal irritation (11.5%). The conversion rate was 26%, and these patients were included in the control group (n=22). Among the laparoscopies (n=63), 36% (n=31) were DL, and 38% (n=32) were TL. The seat belt sign was present in 12% of the patients in the total series. The most frequent therapeutic procedure is suturing of the bladder, colon, and diaphragm. There was correspondence between the CT and intraoperative findings, and there were no unnoticed injuries. The surgical time was longer in the CG (p<0.05).
Conclusion:
Laparoscopy can be safe and effective for the management of patients who are victims of blunt abdominal trauma, selected preoperatively and hemodynamically stable. Success in this type of approach depends on a tripod: adequate selection of patients, trained surgeons and full-time availability of materials and subsidiary tests.