Abdominal trauma – one of the major causes of morbidity and mortality worldwide. It accounts for 9–14.9% of all trauma cases [1] and is very common in the case of young people under the age of 40 years [2]. Laparotomy has traditionally been the standard of care for evaluation and treatment of patients with abdominal trauma [2,3]. Laparoscopic surgery has greatly improved surgical outcome in many areas of abdominal surgery. However, there are many controversial opinions about its safety in abdominal trauma surgery. According to several studies, laparoscopy has a high rate of missed injuries (up to 40%) [4–6], a perceived inability to visualize all areas of the abdomen [6] and it requires surgeons with adequate experience and proper equipments [4,7].
The aim of our study was to estimate the use of laparoscopy in the evaluation and treatment of patients with abdominal trauma. This was a retrospective 4-year (2015-2018) study carried out in the Republican Vilnius university hospital. All abdominal trauma patients managed by operative interventions were included. Patients were divided into two groups: laparotomy and laparoscopy, and were compared with each other. A total of 200 trauma patients were evaluated for abdominal injury. Out of these, 115 (57.50%) underwent surgical intervention for abdominal trauma and were thus included in the study: 24 (20.87%) patients in laparoscopy group and 91 (79.13%) - laparotomy. There was no statistically significant difference in demographic criteria between the groups (p>0.05). The mean age of patients was 42-45 years and the majority of them were males (78.26%). Blunt trauma was sustained by 39 (33.91%) patients and 76 (66.09%) patients sustained penetrating injury (p>0.05). Preoperative imaging was performed to all patients from laparoscopy group and 87% - laparotomy group (>50% experienced two imaging methods). False negative results of the imaging techniques accounted for 20-30% of all the results. False positive results were 4 in laparoscopy group and 6 - laparotomy. Multiple, one and no injuries were presented in 4 (16.67%), 16 (66.66%) and 4 (16.67%) patients of laparoscopy group respectively. Nine (37.50%) patients required conversion to laparotomy: 2 patients (22.22%) after blunt trauma and 7 - penetrating injury (77.78%) due to hollow viscus injuries, intensive bleeding and multiple injuries. Laparotomy was therapeutic for 80 patients (87.91%) including 19 (23.75%) patients with multiple injuries and 61 (76.25%) - single, and was diagnostic for 11 (12.09%) patients. Multiple injuries accounted for 20% of all the cases and the most common injury was the injury of intestines. There was no statistically significant difference in the mean operating time and postoperative complication rates between the groups (p>0.05). But the mean length of hospital stay was in shorten laparoscopy group (p<0.05). No missed injuries were also reported in the laparoscopy group.
According to this retrospective study, we conclude that laparoscopy could become a safe and effective method of treating patients with abdominal trauma. This method might reduce the frequency of unnecessary laparotomies, including laparotomy-related complications and length of hospital stay. We also present a possible algorithm for the use of laparoscopy in the management of abdominal trauma patients based on our limited study and a review of the literature.