Top

World Journal of Surgery

Published in:

01-01-2013

Role of Laparoscopy in Penetrating Abdominal Trauma: A Systematic Review

Authors: Eimer O’Malley, Emily Boyle, Adrian O’Callaghan, J. Calvin Coffey, Stewart R. Walsh

Published in: World Journal of Surgery | Issue 1/2013

Abstract

Background

Debate remains regarding the optimum role of laparoscopy in the setting of trauma although it can offer advantages over traditional exploratory laparotomy. Laparoscopy can be a screening, diagnostic or therapeutic tool in trauma. The purpose of this review is to evaluate the role of laparoscopy in penetrating abdominal trauma

Methods

The PUBMED database was searched with the keywords “Laparoscopy AND Trauma”. Additional citation searching and searching of the grey literature was conducted. Relevant studies were chosen on the basis of the defined inclusion and exclusion criteria and quality was assessed where appropriate using the Downs and Black checklist

Results

In total, 51 studies were included in the analysis of which only 13 were prospective. In most studies, laparoscopy was used as a screening, diagnostic or therapeutic tool. In total, 2569 patients underwent diagnostic laparoscopy (DL) for penetrating abdominal trauma (PAT), 1129 (43.95 %) were positive for injury. 13.8 % of those with injury had a therapeutic laparoscopy. In total 33.8 % were converted to laparotomy, 16 % of which were non-therapeutic and 11.5 % of them were negative. 1497 patients were spared a non-therapeutic laparotomy. Overall, 72 patients suffered complications, there were 3 mortalities and 83 missed injuries. Sensitivity ranged from 66.7–100 %, specificity from 33.3–100 % and accuracy from 50–100 %. 23 of the 50 studies reported sensitivity, specificity and accuracy of 100 %, including the four most recent studies. In general the quality of the reported studies was poor. When used for cohort studies, the mean Downs and Black checklist score was 13.25 out of a possible total of 28.

Conclusions

In summary, laparoscopy in PAT may have an important role in a selected subgroup of patients, with surgeon expertise also an important factor. Laparoscopy has screening, diagnostic and therapeutic roles, particularly where diaphragm injury is suspected. It is extremely sensitive in determining need for laparotomy but detects hollow visceral injuries less reliably. It has potential as a therapeutic tool in centres with appropriate expertise. The development of specific guidelines or protocols may increase the value of laparoscopy in trauma but this would require more evidence of a higher quality.

Shih HC, Wen YS, Ko TJ et al (1999) Noninvasive evaluation of blunt abdominal trauma: prospective study using algorithms to minimise nontherapeutic laparotomy. World J Surg 123:263–270. doi:10.1007/PL00013178

Dapri G, Himpens J, Lipski D et al (2007) Role of laparoscopy in the management of visceral injuries following abdominal stab wounds. J Laparoendosc Adv Surg Tech A 17:713–718PubMedCrossRef

Sitnikov V, Yakubu A, Sarkisyan V et al (2009) The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma. Surg Endosc 23:125–129PubMedCrossRef

Ivatury RR, Simon RJ, Stahl WM (1993) A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 34:822–827PubMedCrossRef

Lin HF, Wu JM, Tu CC et al (2010) Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg 34:1653–1662. doi:10.1007/s00268-010-0485-5 PubMedCrossRef

Choi YB, Lim KS (2003) Therapeutic laparoscopy for abdominal trauma. Surg Endosc 17:421–427CrossRef

Villavicencio RT, Aucar JA (1999) Analysis of laparoscopy in trauma. J Am Coll Surg 189:11–20PubMedCrossRef

Opsanon S, Akaraviputh T, Keorochana K et al (2009) The role of laparoscopic management in suspected traumatic diaphragmatic injury patients: a tertiary care center experience. J Med Assoc Thai 92:903–907

Murray JA, Demetriades D, Asensio JA et al (1998) Occult injuries to the diaphragm: prospective evaluation of laparoscopy in penetrating injuries to the left lower chest. J Am Coll Surg 187:626–630PubMedCrossRef

10.

Murray JA, Demetriades D, Cornwell EE et al (1997) Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. J Trauma 43:624–626PubMedCrossRef

11.

Brandt CP, Priebe PP, Jacobs DG (1994) Potential of laparoscopy to reduce non-therapeutic trauma laparotomies. Am Surg 60:416–420PubMed

12.

Livingston DH, Tortella BJ, Blackwood J et al (1992) The role of laparoscopy in abdominal trauma. J Trauma 33:471–475PubMedCrossRef

13.

Barzana DC, Kotwall CA, Clancy TV et al (2011) Use of laparoscopy in trauma at a level II trauma center. JSLS 15:179–181PubMedCrossRef

14.

Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of healthcare interventions. J Epidemiol Community Health 52:377–384PubMedCrossRef

15.

Kaminskyj A, Frazier M, Johnstone K et al (2010) Chiropractic care for patients with asthma: a systematic review of the literature. J Can Chiropr Assoc 54:24–30PubMed

16.

Kopelman TR, O’Neill PJ, Macias LH et al (2008) The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds. Am J Surg 196:871–877PubMedCrossRef

17.

Powell BS, Magnotti LJ, Schroeppel TJ et al (2008) Diagnostic laparoscopy for the evaluation of occult diaphragmatic injury following penetrating thoracoabdominal trauma. Injury 39:530–534PubMedCrossRef

18.

Rozen WM, Ma EH, Jones IT et al (2007) Emerging epidemic in Australia: abdominal stab wounds—twenty-four months at a major trauma centre. Emerg Med Australas 19:262–268PubMedCrossRef

19.

Friese RS, Coln E, Gentilello LM (2005) Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma 58:789–792PubMedCrossRef

20.

Cherry RA, Eachempati SR, Hydo LJ et al (2005) The role of laparoscopy in penetrating abdominal stab wounds. Surg Laparosc Endosc Percutan Tech 15:14–17PubMedCrossRef

21.

Mahajna A, Mitkal S, Bahuth H et al (2004) Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region. Surg Endosc 18:1485–1487PubMedCrossRef

22.

Miles EJ, Dunn E, Howard D et al (2004) The role of laparoscopy in penetrating abdominal trauma. J Soc Laparoendosc Surg 8:304–309

23.

Taner AS, Topgul K, Kucukel F et al (2001) Diagnostic laparoscopy decreases the rate of unnecessary laparotomies and reduces hospital costs in trauma patients. J Laparoendosc Adv Surg Tech A 11:207–211PubMedCrossRef

24.

Ditmars ML, Bongard F (1996) Laparoscopy for triage of penetrating trauma: the decision to explore. J Laparoendosc Surg 6:285–291PubMedCrossRef

25.

Sosa JL, Baker M, Puente I et al (1995) Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy. J Trauma 38:194–197PubMedCrossRef

26.

Sosa JL, Arrillaga A, Puente I et al (1995) Laparoscopy in 121 consecutive patients with abdominal gunshot wounds. J Trauma 39:501–506PubMedCrossRef

27.

Fernando HC, Alle KM, Chen J et al (1994) Triage by laparoscopy in patients with penetrating abdominal trauma. Br J Surg 81:384–385PubMedCrossRef

28.

Ivatury RR, Simon RJ, Stahl WM (1994) Selective celiotomy for missile wounds of the abdomen based on laparoscopy. Surg Endosc 8:366–370PubMedCrossRef

29.

Dalton JM, DeMaria EJ, Gore DC et al (1994) Prospective evaluation of laparoscopy in abdominal stab wounds. J Trauma 36:149CrossRef

30.

Ivatury RR, Simon RJ, Weksler B et al (1992) Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating Injury. J Trauma 33:101–108PubMedCrossRef

31.

Sosa JL, Sims D, Martin L et al (1992) Laparoscopic evaluation of tangential abdominal gunshot wounds. Arch Surg 127:109–110PubMedCrossRef

32.

Carnevale N, Baron N, Delany HM (1977) Peritoneoscopy as an aid in the diagnosis of abdominal trauma: a preliminary report. J Trauma 17:634–641PubMedCrossRef

33.

Heselson J (1970) Peritoneoscopy in abdominal trauma. S Afr J Surg 8:53–61PubMed

34.

Ahmed N, Whelan J, Brownlee J et al (2005) The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg 201:213–216PubMedCrossRef

35.

Leppaniemi A, Happianen R (2003) Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomised study. J Trauma 55:636–645PubMedCrossRef

36.

DeMaria EJ, Dalton JM, Gore DC et al (2000) Complementary roles of laparoscopic abdominal exploration and diagnostic peritoneal lavage for evaluating abdominal stab wounds: a prospective study. J Laparoendosc Adv Surg Tech A 10:131–136PubMedCrossRef

37.

Elliot DC, Rodriguez A, Moncure M et al (1998) The accuracy of diagnostic laparoscopy in trauma patients: a prospective, controlled study. Int Surg 83:294–298

38.

Mutter D, Nord M, Vix M et al (1997) Laparoscopy in the evaluation of abdominal stab wounds. Dig Surg 14:39–42CrossRef

39.

Brefort JL, Samama G, Le Roux Y et al (1997) Contribution of laparoscopy in the management of abdominal stab wounds. Ann Chir 51:697–702PubMed

40.

Ortega AE, Tang E, Froes ET et al (1996) Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries. Surg Endosc 10:19–22PubMedCrossRef

41.

Ertekin C, Yamaner S, Güloglu R et al (1997) The role of diagnostic laparoscopy in treatment of penetrating injuries of the lower thoracic wall and anterior abdominal wall. Zentralbl Chir 122:535–537PubMed

42.

De Watteville JC, Molinier N, Gayral F (1995) Value of celioscopy in the diagnosis of abdominal wounds. Ann Chir 49:602–606PubMed

43.

Rossi P, Mullins D, Thal E (1993) Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg 166:707–711PubMedCrossRef

44.

Biffl WL, Kaups KL, Pham TN et al (2011) Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 71:1494–1502PubMedCrossRef

45.

Yucel T, Gonullu D, Matur R et al (2010) Laparoscopic management of left thoracoabdominal stab wounds: a prospective study. Surg Laparosc Endosc Percutan Tech 20:42–45PubMedCrossRef

46.

Clarke DL, Greatorex B, Oosthuizen GV et al (2009) The spectrum of diaphragmatic injury in a busy metropolitan surgical service. Injury 40:932–937PubMedCrossRef

47.

Dissanaike S, Griswold JA, Frezza EE (2005) Treatment of isolated penetrating flank trauma. Am Surg 71:493–496PubMed

48.

Mitra B, Gocentas R, O’Reilly G et al (2007) Management of haemodynamically stable patients with abdominal stab wounds. Emerg Med Australas 19:269–275PubMedCrossRef

49.

Shaw JM, Navsaria PH, Nicol AJ (2003) Laparoscopy-assisted repair of diaphragmatic injuries. World J Surg 27:671–674. doi:10.1007/s00268-003-6747-8 PubMedCrossRef

50.

Fabiani P, Iannelli A, Mazza D et al (2003) Diagnostic and therapeutic laparoscopy for stab wounds of the anterior abdomen. J Laparoendosc Adv Surg Tech A 13:309–312PubMedCrossRef

51.

Hallfeldt KKJ, Trupka AW, Erhard J et al (1998) Emergency laparoscopy for abdominal stab wounds. Surg Endosc 12:907–910PubMedCrossRef

52.

Ertekin C, Onaran Y, Guloglu R et al (1998) The use of laparoscopy as a primary diagnostic and therapeutic method in penetrating wounds of lower thoracal region. Surg Laparosc Endosc 8:26–29PubMedCrossRef

53.

Smith RS, Fry WR, Morabito DJ et al (1995) Therapeutic laparoscopy in trauma. Am J Surg 170:632–637PubMedCrossRef

54.

Ertekin C, Yanar H, Taviloglu K et al (2005) Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J 22:790–794PubMedCrossRef

55.

Gazzaniga AB, Stanton WW, Bartlett RH (1976) Laparoscopy in the diagnosis of blunt and penetrating injuries to the abdomen. Am J Surg 31:315–318CrossRef

56.

Kawahara NT, Alster C, Fujimura I et al (2009) Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 67:589–595PubMedCrossRef

57.

Mallat AF, Mancini ML, Daley BJ et al (2008) The role of laparoscopy in trauma: a ten-year review of diagnosis and therapeutics. Am Surg 74:1166–1170PubMed

58.

Kaban GK, Novitsky YW, Perugini RA et al (2008) Use of laparoscopy in evaluation and treatment of penetrating and blunt abdominal injuries. Surg Innov 15:26–31PubMedCrossRef

59.

Simon RJ, Rabin J, Kuhls D (2002) Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma 53:297–302PubMedCrossRef

60.

Marks JM, Youngelman DF, Berk T (1997) Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 11:272–276PubMedCrossRef

61.

Zantut LF, Ivatury RR, Smith RS et al (1997) Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 42:825–831PubMedCrossRef

62.

Schrenk P, Woisetschläger R, Wayand WU et al (1994) Diagnostic laparoscopy: a survey of 92 patients. Am J Surg 168:348–351PubMedCrossRef

63.

Fabian TC, Croce MA, Stewart RM et al (1993) A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg 217:557–565PubMedCrossRef

64.

Dunn D, Nair R, Fowler S et al (1994) Laparoscopic cholecystectomy in England and Wales: results of an audit by the Royal College of Surgeons in England. Ann R Coll Surg Engl 76:269–275PubMed

65.

The Southern Surgeons Club (1995) The learning curve for laparoscopic cholecystectomy. Am J Surg 1170:55–59CrossRef

66.

Tekis P, Senagore A (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91CrossRef

67.

Bennett CL, Stryker CJ, Ferreira MR et al (1997) The learning curve for laparoscopic colorectal surgery: preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132:41–44PubMedCrossRef

68.

Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer. Lancet 365:1718–1726PubMedCrossRef

69.

Clinical Outcomes of Surgical Therapy Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef

Title: Role of Laparoscopy in Penetrating Abdominal Trauma: A Systematic Review
Authors: Eimer O’Malley
Emily Boyle
Adrian O’Callaghan
J. Calvin Coffey
Stewart R. Walsh
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 1/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-012-1790-y

At a glance: The STEP trials

Springer Medicine

Role of Laparoscopy in Penetrating Abdominal Trauma: A Systematic Review

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Trans-cutaneous Closure of Central Defects (TCCD) in Laparoscopic Ventral Hernia Repairs (LVHR)

Preoperative Assessment of Tumor Location and Station-Specific Lymph Node Status in Patients with Adenocarcinoma of the Gastroesophageal Junction

Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population-Based Analysis of 2,537 Women

Risk Factors of Hypoparathyroidism Following Total Thyroidectomy for Thyroid Cancer

Predicting Hollow Viscus Injury in Blunt Abdominal Trauma with Computed Tomography

Three-Dimensional CT Volumetry Predicts Outcome of Laparoscopic Splenectomy for Splenomegaly: Retrospective Clinical Study