Therapeutic laparoscopy in trauma: the new paradigm.
Article Type: Report
Subject: Laparoscopic surgery (Methods)
Laparoscopy (Methods)
Diaphragm (Injuries)
Authors: Koto, Z.
Isakov, R.
Lunda, S.
Pub Date: 04/01/2011
Publication: Name: South African Journal of Surgery Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0038-2361
Issue: Date: April, 2011 Source Volume: 49 Source Issue: 2
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 257675316
Full Text: Introduction: Laparoscopy in trauma is controversial at best and regarded as dangerous in some circles. Earlier data published in the early 1990s reported a high missed rate of small-bowel injury in particular. These early data set off a firestorm in this arena and many trauma surgeons have been very reluctant to embrace it in trauma care.

Aim: We document our results using laparoscopy in treating trauma patients in our unit.

Methods: We prospectively collected the records of all patients treated at our institution using minimally invasive surgery. The patients' demographic data, operative findings, procedure and outcomes were looked at during January 2009 and January 2011. We excluded patients who had a soft abdomen with lower stab chest with suspected diaphragm injury, as these have routine diagnostic laparoscopy in our unit.

Results: During this time 47 patients were treated using this modality (28 males, 19 females). They were all haemodynamically stable with a tender abdomen or suspected intra-abdominal injury. Six had disembowelment, 4 gunshot wounds of the abdomen, 23 stab wounds of the abdomen, 12 blunt abdominal trauma, and 2 suspected diaphragm injury with a tender abdomen.

Procedures done were repair of the colon (6 cases), small-bowel repair (12), combined small-bowel and colon repair (4), stomach repair and diaphragm repair (9), splenectomy (2), bladder repair (4), cholecystectomy and hepatorrhaphy (2), non-remedial laparoscopy (8), and conversion to open (5). The mean operating time was 2 hours and the average hospital stay 4 days. Complications were missed injury in 1 case, resulting in fistulas, multiple organ failure and death, wound sepsis (2), pneumonia (1), and prolonged ileus (1).

Conclusion: There is cautious optimism that minimally invasive surgery may have a role in trauma. The caveat is that it should be done in a closely supervised environment by trained individuals.

Z Koto, R Isakov, S Lunda

University of the Witwatersrand, Johannesburg
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