Conservative Versus Delayed Laparoscopic Exploration for Blunt Abdominal Trauma
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- Category: Vol. 80, September 2012
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Conservative Versus Delayed Laparoscopic Exploration for Blunt Abdominal Trauma,TAMER M. NABIL, SALAH S. SOLIMAN, WAEL N. THABET and RAMI M. MAKKAR
Abstract
Introduction: The key issue in the choice of investigation is the cardiovascular stability of the patient. Diagnostic peritoneal lavage (DPL) is no longer the gold standard for determination of the need for laparotomy in blunt abdominal trauma not only because more specific and sensitive diagnostic procedures are available like delayed laparoscopic exploration (DLE), but also to avoid the unnecessary laparotomies even in cases of true positive DPL. The aim of this study is to compare conservative versus DLE for blunt abdominal trauma management as regards accuracy of diagnosis, decreasing incidence of complication, decreasing the need for unnecessary laparotomies and to shorten the hospital stay.
Material and Methods: 28 hemodynamically stable patients with blunt abdominal trauma (BAT) were selected randomly and divided into two groups, there was no statistically signif-icant difference in the mode of trauma between the two groups using the rank student t-test, also, no statistically significant difference in the age and the sex distribution between the two groups, as they passed the normality test.
Group (A): Included 15 patients, managed by the classic conservative management with close monitoring by vital signs, urine output, laboratory tests and repeated imaging by abdominal US.
Group (B): Included 13 patients managed by (DLE) at the third day of the trauma, patients had US, CT abdomen on admission and remain under observation till the third day. Follow-up for the patients from both groups after discharge to detect late complications after 3 months.
Results: In 9 patients included in the study representing approximately 32% of all patients, there were injuries missed by U/S and detected by CT. And in 17 patients representing approximately 64%, U/S and CT detected the same injuries. Among the 13 patients that underwent delayed laparoscopic exploration (DLE) representing approximately 46% of all patients there were 5 missed injuries by CT that was discovered during (DLE) representing 38% of the 13 patients. Therapeutic laparoscopic intervention occurred in 3 patients representing approximately 23% of the 13 patients. Hospital stay for the patients managed with (DLE) ranged between 4 to 10 days with an average of 5.69 days (±1.887). Hospital stay for the patients managed with conservative management ranged between 5 to 14 days with average of 8.93 days (±2.89). Follow-up information was available for all the patients over a period of 3 months after discharge, neither infective nor late hemorrhagic complications were observed.
Conclusion: In the light of this study, (DLE) was found most significant for blunt abdominal trauma patients with CT scan showing haemoperitonium with no organ injuries, and to less extent in cases with splenic injuries, while in patients with hepatic injuries there was no significant data favoring (DLE) on conservative treatment.