‘A STUDY ON ROLE OF

LAPAROSCOPY IN

ABDOMINAL TRAUMA’

PRESENTED BY

DR.DEVENDRAN

GENERAL SURGERY. DNB

A STUDY ON ROLE OF

LAPAROSCOPY IN ABDOMINAL

TRAUMA• INTRODUCTION.• Road traffic accidents are the most common cause of

abdominal injuries.

• he environment that human being has created exposes him to variety In tof injuries.

• Other mode of injuries are falls,crimes and assults,wars,social conflicts automobiles pedestrian accidents etc.

• For Abdominal trauma patients requires a art of resuscitation,early diagnosis,intial evaluation and manage ment and lastly perfect surgical skills…

• In abdominal trauma most commonly injured organ SPLEEN [45 to 55] folled by liver[35to45], kidney

• Due to research and advances in diagnostic field like USG,DPL,CT scan abdomen,laparoscopy chances of negative laparotomies significantly reduced..

• With advent and development of new technology laparoscopy minimal access surgery has diagnostic and definitive therapeutic role in abdominal trauma.

• In the past laparoscopy only limited to dignosticpurpose, but now a days there is availability of sohisticated equipments ,instruments.laparoscopy is being used more and more for diagnostic as well as therapeutic measure…

BRIEF HISTORY OF LAPAROSCOPY

• Laparoscopy surgery developed over many decades. Difficult to pinpoint one individual pioneer to approach..

• In 1902. sirGeorg Kelling.. From Dresden .Jermany Performed laparoscopy in dogs.

• In 1910 sir Hons christian Jacobeus. From Swedon performed laparoscopy in humans. Abdomen and thoracic injuries..

• Next few decades popularised by number of persons..

• First laparoscopy cholecystectomy performed by sir Erich Muhe..

• First appendicectomy performed by sir Kurt semp. In 1981.

• In 1956 sir Lamy used laparoscopy for splenic trauma patients.

• Laparoscopic splenectomy performed by Sutherland…

REVIEW OF LITERATURE

• A Journal of the society of laparoscopic surgeons[JSLS]2011’ publication from north carolia USA.

• A retrospectrive review of all trauma patients undergone diagnostic and therapeutic laparoscopy was pereformed from 2001 to2010.

• Laparoscopy performed in 16 patients. Average age 35 yrs. Most of the injuries due to mtor vehicle accidents ,falla,stabs..

• Dignostic lap performed in 11[69%]. Among this 3 only requiring to conversion to open procedure..

• Successful therapeutic lap was performed for 5 for repair of isolated injuries. To diaphragm,smallbowel, colon injuries.

• CONCLUSION..

• With this study they concluded diagnostic lap is better and avoids un necessary laparotomies

• JOURNALS OF THE SOCIETY OF LAPAROSCOPIC SURGEONS. JSLS.1998..

• A prospective case series conducted in new york..1995 to1997. bellevue hospital trauma and shock unit..

• 70 consecutive patients were evaluated over 2 yr period. . Avarage length of the stay for laparoscopy only 1.5 days.. For negative celiotomy 5.2 dfays

age group 16 to 64. males 64[91%] females9[9%] among this 44[63%] ant abdominal wall injury. 16 stab injury 13 gun shots injury..

Evaluated laparoscopy after indeterminate CT scan’’

CONCLUSION…

Oparative time is reduced [16 to60min]’

Length of stay in hospitals reduced.. 1.5 days

Morbity decreased..

Anaesthesia related complications min… no tension pneumothorax…

• No intra abdominal injuries missed in laparoscopy.. 2 out of ten left lower chest require urgent surgery for missed ongoing hemothorax.

• With this study and experience they concluded laparoscopy is the safe and accurate tool for identifying abdominal injuries .decreases negative laparotomies

THE INTERNET JOURNAL OF SURGERY .2013. VOL.30. NOVEMBER 4.

Conducted aclinical study in laparoscopy in diagnostic and management of acute abdomen in south indian population.

50 cases of acute abdomen was done to study the role of laparoscopy in dignostic and therapeutic purpose in acute abdomen.

• Out of 50 cases studied 27[54%] were male. 23[46%] were female patients. Average age 30.5 yrs..

• Abdominal pain was the universal complaint present in all 50 patients.[100%]

• Vomiting was present in 42[84%] patients.

• Fever in 31[62%]

• Abdominal distension in 12[24%].

• Alteration in bowel habbits noted in 9[18%]

• Burning micturition in 5[10%]

• In this study 9[18%] patients had previous surgery.

• Laparoscopy was diagnostic in 50[100%] cases. Could accomplish treatment in47 [94%] patients..

• Unnecessary laparotomy were avoided in 7 patients.

• Only 3 converted into laparotomy.

• CONCLUSION.

• This study establishes the fact that laparoscopy is a very accurate tool in diagnosis and treatment of acute abdomen.

• Non therapeutic laparotomies avoided less hospital stay.

• WORLD JOURNAL OF EMERGENCY SURGERY 2006 also conducted stydy on diagnostic and therapeutic purpose of laparoscopy..

• They concluded laparoscopy is an excellent modality in acute abdomen and diaphragm injuries.

AIMS AND OBJECTIVES

• TO KNOW THE MODE OF INJURY AND incidence of organ involvement in abdominal trauma patients.

• To study the management of trauma abdomen in different mode of injuries

• To find out the diagnostic and therapeutic role of laparoscopy in abdominal trauma patients.

• To reduce the incidence of negative laparotomies.

• To find out the limitations and contra indications of laparoscopy in abdominal trauma patients.

• To review the method of patient selection ,operative technique, operative time ,intra operative and post operative complications.

• To find out the impact of laparoscopy on patients with trauma abdomen in terems of early rehabilitation ,cost effective ness , decreased hospital stay and cosmosis

INDICATIONS FOR LAPAROSCOPY

• Those cases CT is inconclussive diagnostic laparoscopy is indicated.

• Those cases requiring surgical intervention minimal acces laparoscopy can be performed.

• Hemodynamically stable patients.

• Diagnostic peritoneal lavage[DPL] positive cases.

• USG/FAST positive..

• Some abdominal injury positive with intialdiagnostic procedures.

• Some prospectrive sudies conducted median sge groupe 23 for most of lap patients. Range between 11 to 20 yrs and 21 to 30 yrs

POTENTIAL ADVANTAGES OF LAPAROSCOPY

• Main advantages of laparoscopy are

• Small incision

• Quick recovery

• Less pain

• Short post operative hospital stay

• Cosmatically good compared with laparotomy.

• Easy mobilisation.

• Min post operative complications

LIMITATIONS OF LAPAROSCOPY

• Inability to visualise entire abdominal cavity.

• Especially retroperitoneum and posterior diaphragm.

• Hemopritoneum may not be clearly visible by lap due to unclear field.

• Some times hollow viscus perforations missed with laparoscopy lead to prolanged leak and complications

Contraindications for laparoscopy

• Trauma with EDH/SDH.• Abdominal associate with some compound spine

fractures, severe chest injuries…• Hemodynamically instability.• In difficult intubation.• Pregnacy.• Uncontrolled coagulopathy.• Patients with multiple previous laparotomies.• Massive intestinal dilatation with abdominal

distension.

• METHOD.

• patients were given general anaesthesia in supine position.

• first trocar insertwed at supra umbilical ridge with open hassans method with pneumopritoneum with pressure 12 to15 mm of hg.

• Pneumoperitoneum created with co2. it is un inflammed and least irritant gas. So it is comonlyused.

• Other port site created under direct vision.

• The standard three main ports are umbilical port , rt sided port and left sided port..

• Extra port is made according to organ injury

Some complications of laparoscopy

• Laparoscopy is a commonly pereformed preocrdure

• Complications are very minimal

• Complications are minor and major complications..

• Minor are

• Feeling sick ,fever, vomiting

• Minor bleeding and bruicing around the incision

• Post op infection.

• V.rarly port site hernias..

• Urinary retention

• MAJOR are

• damage to organ such as bowel or bladder.

• which could result in the loss of organ function.

• Damage to major artry

• Complications can occur with CO2 such as bubles entering in to veins and arteries throbosis

• Some times pul embolism can occur

• In lap cholecystectomy some bile duct injuries are common.

• Miss identification of cystic duct with common bile duct and common hepatic duct..

• Delayed stricture due to thermal injury