Skip to main content
Top
Published in: Surgical Endoscopy 1/2009

01-01-2009

The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma

Authors: Viktor Sitnikov, Abdulkadir Yakubu, Vagan Sarkisyan, Michail Turbin

Published in: Surgical Endoscopy | Issue 1/2009

Login to get access

Abstract

Background

Patients with small bowel injuries (SBI) in abdominal trauma have no clear clinical or radiological signs on initial examination. This leads to delay in appropriate surgical interventions with consequent high morbidity and mortality. In this paper we demonstrate the role of video-assisted laparoscopy (VAL) in management of such patients.

Methods and materials

819 patients with SBI were evaluated retrospectively between 1994 and 2003. The mechanism of the trauma was blunt in 146 (17.8%) patients and stab wounds in 640; routine investigations and VAL were used for triage of the subjects. All the victims underwent laparotomy or video-assisted laparoscopy. Demographic information, incidence of organs injuries, types of surgery, complications, associated injuries, and hospital mortality were analyzed.

Results

Diagnostic video laparoscopy was sufficient for 518 (63.2%) patients. Small bowel repair was performed in 332 (40.6%) patients, clipping of mesenteric blood vessels in 27 (3.4%) patients, and coagulation and ligation of omental blood vessels in 48 (5.9%) patients. Ninety-seven (11.8%) patients with small bowel injury were associated with postoperative complications. There were 19 (2.3%) deaths associated with hemoperitoneum, severe head injury, and multiple ribs fracture. Generalized peritonitis was revealed in one case and focal abscesses between intestinal loops were identified in another one patient.

Conclusion

The DVAL findings of visceral injuries give optimal approach for management of small bowel injuries in abdominal trauma.
Literature
2.
go back to reference Dubravka V, Alojz P, Martin T (2003) Diagnosis of bowel injuries from blunt abdominal trauma. Eur J Trauma 29(8):220–227 Dubravka V, Alojz P, Martin T (2003) Diagnosis of bowel injuries from blunt abdominal trauma. Eur J Trauma 29(8):220–227
3.
go back to reference Watts DD, Fakhry SM (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275, 557 trauma admissions from the EAST multi-institutional trial. J Trauma 54(2):289–294PubMedCrossRef Watts DD, Fakhry SM (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275, 557 trauma admissions from the EAST multi-institutional trial. J Trauma 54(2):289–294PubMedCrossRef
4.
go back to reference Leppaniemi AK, Haapiainen RK (1996) Selective nonoperative management of abdominal stab wounds: prospective, randomized study. World J Surg 20(8):1101–1105PubMedCrossRef Leppaniemi AK, Haapiainen RK (1996) Selective nonoperative management of abdominal stab wounds: prospective, randomized study. World J Surg 20(8):1101–1105PubMedCrossRef
5.
go back to reference Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds: a prospective study of 651 patients. Ann Surg 205(2):129–132PubMedCrossRef Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds: a prospective study of 651 patients. Ann Surg 205(2):129–132PubMedCrossRef
6.
go back to reference Gonzalez RP, Turk B, Falimirski ME et al (2001) Abdominal stab wounds: diagnostic peritoneal lavage criteria for emergency room discharge. J Trauma 51(5):939PubMedCrossRef Gonzalez RP, Turk B, Falimirski ME et al (2001) Abdominal stab wounds: diagnostic peritoneal lavage criteria for emergency room discharge. J Trauma 51(5):939PubMedCrossRef
7.
go back to reference Feliciano D, Bitondo GC, Steed G (1984) Five hundred open taps or lavages in patients with abdominal stab wounds. Am J Surg 148:772–777PubMedCrossRef Feliciano D, Bitondo GC, Steed G (1984) Five hundred open taps or lavages in patients with abdominal stab wounds. Am J Surg 148:772–777PubMedCrossRef
8.
go back to reference Dennis W, George B, Leon M, Margaret P, Lorenz D (1988) Mini-laparoscopy in blunt abdominal trauma. Surg Endosc 3(10):184–189 Dennis W, George B, Leon M, Margaret P, Lorenz D (1988) Mini-laparoscopy in blunt abdominal trauma. Surg Endosc 3(10):184–189
9.
go back to reference Lujan A, Parrilla P, Robles R, Torralba J, Sanchez F, Arenas J (1995) Laparoscopic surgery in the management of traumatic hemoperitoneum in stable patients. Surg Endosc 9(8):879–881 Lujan A, Parrilla P, Robles R, Torralba J, Sanchez F, Arenas J (1995) Laparoscopic surgery in the management of traumatic hemoperitoneum in stable patients. Surg Endosc 9(8):879–881
10.
go back to reference Friese R, Coln C, Gentilello L (2005) Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma Injury Infect Crit Care 58(4):789–792CrossRef Friese R, Coln C, Gentilello L (2005) Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma Injury Infect Crit Care 58(4):789–792CrossRef
11.
go back to reference Marks JM, Youngelman DF, Berk T (1993) Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 3(3):272–276 Marks JM, Youngelman DF, Berk T (1993) Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 3(3):272–276
12.
go back to reference Frakhry SM (1999) Relatively short diagnostic delays produce morbidity and mortality in blunt bowel injury: an analysis of time to operation intervention in 202 patients in multicenter experience. J Trauma 47–207 Frakhry SM (1999) Relatively short diagnostic delays produce morbidity and mortality in blunt bowel injury: an analysis of time to operation intervention in 202 patients in multicenter experience. J Trauma 47–207
13.
go back to reference Zantut LF (1997) Diagnostic and therapeutic laparoscopy in penetrating abdominal trauma: a multicenter experience. J Trauma 42(5):825–831PubMedCrossRef Zantut LF (1997) Diagnostic and therapeutic laparoscopy in penetrating abdominal trauma: a multicenter experience. J Trauma 42(5):825–831PubMedCrossRef
14.
go back to reference Fakhry SM, Brownstein M, Watts DD et al (2000) Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 48(3):408–415PubMedCrossRef Fakhry SM, Brownstein M, Watts DD et al (2000) Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 48(3):408–415PubMedCrossRef
15.
go back to reference Brundage SI, Jurkovich GJ, Hoyt DB et al (2001) Stapled versus sutured gastrointestinal anastomosis in the trauma patient: a multicenter trial. J Trauma 51(6):1054–1061PubMedCrossRef Brundage SI, Jurkovich GJ, Hoyt DB et al (2001) Stapled versus sutured gastrointestinal anastomosis in the trauma patient: a multicenter trial. J Trauma 51(6):1054–1061PubMedCrossRef
Metadata
Title
The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma
Authors
Viktor Sitnikov
Abdulkadir Yakubu
Vagan Sarkisyan
Michail Turbin
Publication date
01-01-2009
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9910-3

Other articles of this Issue 1/2009

Surgical Endoscopy 1/2009 Go to the issue

News and notices

News and notices