Oleh Yevhenovych Matsevych1, Modise Zacharia Koto2, Colleen Aldous3. 1. Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa; University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa. Electronic address: info@matsevych.com. 2. Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa; University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa. 3. University of KwaZulu - Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa.
Abstract
BACKGROUND: Therapeutic laparoscopy (TL) for penetrating abdominal trauma (PAT) is controversial because the management of multiple bowel injuries is challenging and the conversion rate is high. However, the laparoscopic-assisted approach (LAA) allows easy management of multiple bowel injuries but not investigated in a trauma setting. The aim of this study was to investigate its role in management of multiple bowel injuries and to compare LAA with therapeutic laparoscopy performed fully laparoscopically (FTL). METHODS: All adult patients with PAT managed with TL over four-year period were analyzed. Intraoperative findings, trauma scoring, grading of bowel injuries, related procedures, outcomes and length of hospital stay (LOS) were compared between LAA and FTL groups. RESULTS: Seventy two (53%) patients were in the FTL group and 65 (47%) in the LAA group. The majority of patients presented with stab wounds. Colonic and small bowel injuries were more common in the LAA group (19 versus 17 and 47 versus 8, respectively). The higher number of bowel repairs, resections and anastomosis were performed in the LAA group. The ISS was higher in the FTL group (13 versus 11, p = 0.02), and the PATI was higher in the LAA group (6 versus 10, p < 0.001). Nine patients in the FTL group suffered Clavien-Dindo grade 3 complications and 11 patients in the LAA group. There was one death in each group. No missed injuries were reported. There was no significant difference in LOS between groups. CONCLUSIONS: The LAA is safe in the management of stable patients with PAT. It can used for management of multiple bowel injuries instead of a conversion to laparotomy. It provides benefits of minimally invasive surgery and the speed and versatility of laparotomy. Moreover, the LAA seems not to be inferior to entirely laparoscopic therapeutic procedures. More studies are needed to compare LAA with FTL and laparotomy.
BACKGROUND: Therapeutic laparoscopy (TL) for penetrating abdominal trauma (PAT) is controversial because the management of multiple bowel injuries is challenging and the conversion rate is high. However, the laparoscopic-assisted approach (LAA) allows easy management of multiple bowel injuries but not investigated in a trauma setting. The aim of this study was to investigate its role in management of multiple bowel injuries and to compare LAA with therapeutic laparoscopy performed fully laparoscopically (FTL). METHODS: All adult patients with PAT managed with TL over four-year period were analyzed. Intraoperative findings, trauma scoring, grading of bowel injuries, related procedures, outcomes and length of hospital stay (LOS) were compared between LAA and FTL groups. RESULTS: Seventy two (53%) patients were in the FTL group and 65 (47%) in the LAA group. The majority of patients presented with stab wounds. Colonic and small bowel injuries were more common in the LAA group (19 versus 17 and 47 versus 8, respectively). The higher number of bowel repairs, resections and anastomosis were performed in the LAA group. The ISS was higher in the FTL group (13 versus 11, p = 0.02), and the PATI was higher in the LAA group (6 versus 10, p < 0.001). Nine patients in the FTL group suffered Clavien-Dindo grade 3 complications and 11 patients in the LAA group. There was one death in each group. No missed injuries were reported. There was no significant difference in LOS between groups. CONCLUSIONS: The LAA is safe in the management of stable patients with PAT. It can used for management of multiple bowel injuries instead of a conversion to laparotomy. It provides benefits of minimally invasive surgery and the speed and versatility of laparotomy. Moreover, the LAA seems not to be inferior to entirely laparoscopic therapeutic procedures. More studies are needed to compare LAA with FTL and laparotomy.