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ORIGINAL ARTICLE
Year : 2018  |  Volume : 37  |  Issue : 2  |  Page : 166-171

Value of laparoscopic exploration of penetrating abdominal trauma


Lecturer of General Surgery Faculty of Medicine, Cairo University, Egypt

Correspondence Address:
Ahmed A Al Aziz
Lecturer of General and Laparoscopic Surgery, Cairo University
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_118_17

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Objective The aim was to evaluate the role of laparoscopy in the management of patients with penetrating abdominal trauma. Patients and methods This prospective study included 60 hemodynamically stable patients with penetrating abdominal trauma presenting to the Casualty Department. The patients were subjected to routine investigations including routine laboratory and radiological investigations and were randomly divided into two groups: local wound exploration (LWE) group (n=30) and laparoscopy group (n=30). In the LWE group, the patients were subjected to LWE under local anesthesia followed by laparotomy if the wound penetrated the deep fascia. In the laparoscopy group, the patients were subjected to diagnostic laparoscopy and managed laparoscopically or converted to laparotomy according to the circumstances. Otherwise, the patient was discharged within 24 h. Results In the LWE group, six (20%) patients were discharged as having intact peritoneum; one of them was back 2 days later, had exploratory laparotomy and a small bowel injury was repaired. A total of 24 (80%) patients with perforated peritoneum proceeded to laparotomy; 17 (56.7%) of them had negative laparotomy. In the laparoscopy group 18 (60.0%) patients showed negative laparoscopy, four (13.3%) patients were managed laparoscopically, and eight (26.7%) were converted to laparotomy. Thus, 33 laparotomies were performed; the rate of complications was 39.4% with significant difference between negative and therapeutic cases (P=0.619). The operative time and hospital stay were significantly longer in cases of laparotomy compared with laparoscopy (P<0.001). Conclusion Routine laparotomy has a negative rate of 57%. Laparoscopy did not miss intra-abdominal injuries, was therapeutically effective in 12%, and was negative in 60% of cases.


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