World Journal of Laparoscopic Surgery

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VOLUME 2 , ISSUE 2 ( May-August, 2009 ) > List of Articles

RESEARCH ARTICLE

Diagnostic and Therapeutic Laparoscopy in Various Blunt Abdomen Trauma

VD Gohil, HD Palekar, M Ghoghari

Citation Information : Gohil V, Palekar H, Ghoghari M. Diagnostic and Therapeutic Laparoscopy in Various Blunt Abdomen Trauma. World J Lap Surg 2009; 2 (2):42-47.

DOI: 10.5005/jp-journals-10007-1025

Published Online: 01-08-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

abdomen is the “Black box” i.e., it is impossible to know what specific injuries have occurred at initial evaluation. The key to saving lives in abdominal trauma is NOT to make an accurate diagnosis, but rather to recognize that there is an abdominal injury. Minimal-access surgery is an integral component of the alternative surgery management paradigm. The addition of videoscopic technology to intracavitary endoscopy has led to a tremendous expansion of indications for minimal-access procedures in all fields of surgery. The use of laparoscopy to assess the peritoneal cavity for injury is not a new concept. Reports by Tostivint et al, Gazzaniga et al, and Carnevale et al discussed the possibilities of using this minimally invasive approach to evaluate the peritoneal cavity for injuries. Laparoscopy has become an important diagnostic and therapeutic tool in the treatment of both blunt and penetrating traumatic injuries. Laparoscopy has been shown to be valuable in detecting occult diaphragmatic injuries in locations where computed tomography (CT) scanning and diagnostic peritoneal lavage have recognized limitations. Notably, laparoscopy can also provide therapeutic interventions in certain circumstances as well. Simultaneous gastric and diaphragmatic injuries have been repaired using this approach. Laparoscopy has been used to repair blunt traumatic solid organ injuries, including a subcapsular splenic hematoma. Blunt hepatic injuries have been successfully treated laparoscopically with the instillation of fibrin glue. A duodenal hematoma has been decompressed laparoscopically. Importantly, in trauma patients with potential intracranial injuries, laparoscopy should be used cautiously because of the risk of increased intracranial pressure. Laparoscopy is also potentially hazardous in patients with acute respiratory distress syndrome, because lung compliance and effective gas exchange may be further decreased by the pneumoperitoneum. Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. The most important advantages are reduction of morbidity, shortening of hospitalization and cost effectiveness. In the future, new development in laparoscopy equipment and the introduction of computer technology and robotic devices can be expected to have a decisive influence on the treatment of trauma patients.


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