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Wertigkeit der Laparoskopie beim penetrierenden und stumpfen Abdominaltrauma – ein systematisches Review

Value of laparoscopy in blunt and penetrating abdominal trauma—a systematic review

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Zusammenfassung

Hintergrund

Die Indikationen zur Laparoskopie haben sich in den letzten Jahren stetig erweitert. Gleichzeitig bleibt der diagnostische und therapeutische Stellenwert der Laparoskopie beim penetrierenden und stumpfen Abdominaltrauma weiter unklar.

Material und Methoden

Es wurde eine systematische Literaturrecherche über den Zeitraum 2008 bis 2019 in PubMed zum Thema Laparoskopie beim penetrierenden und stumpfen Abdominaltrauma durchgeführt. Die Studien wurden hinsichtlich relevanter perioperativer Ereignisraten (übersehene Verletzungen, Konversionsrate, tatsächlich vorliegende Verletzungen, postoperative Komplikationen) ausgewertet. Auf dieser Basis wurde ein Algorithmus zur Anwendung der Laparoskopie beim Abdominaltrauma erstellt.

Ergebnisse

Es wurden 15 Volltexte mit 5869 Patienten gefunden. Mit einer Rate von 1,4 % waren laparoskopisch übersehene Verletzungen sowohl für das penetrierende als auch für das stumpfe Abdominaltrauma sehr selten. Von allen Traumalaparoskopien wurden 29,3 % zum offen chirurgischen Vorgehen (Laparotomie) konvertiert. Unter den nichtkonvertierten Laparoskopien waren 60,5 % therapeutisch. Komplikationen traten nach Traumalaparoskopie in 8,6 % der Fälle auf.

Schlussfolgerung

Mittels systematischer laparoskopischer Exploration sind übersehene Verletzungen beim Abdominaltrauma äußerst selten, sodass diesbezügliche Bedenken kaum mehr gerechtfertigt erscheinen. Ein großer Anteil der bestehenden intraabdominalen Verletzungen kann laparoskopisch oder laparoskopisch-assistiert therapiert werden.

Abstract

Background

The range of indications for laparoscopic procedures has been continuously widened in recent years. At the same time, however, the diagnostic and therapeutic role of laparoscopy in the management of blunt and penetrating abdominal trauma remains controversial.

Methods

A systematic literature search was carried out in PubMed from 2008 to 2019 on the use of laparoscopy in blunt and penetrating abdominal trauma. Studies were analyzed in terms of relevant operative and perioperative event rates (rate of missed injuries, conversion rate, postoperative complication rate). On the basis of this analysis, an algorithm for the use of laparoscopy in abdominal trauma was developed for clinical practice.

Results

A total of 15 full texts with 5869 patients were found. With a rate of 1.4%, laparoscopically missed injuries were very rare for both penetrating and blunt abdominal trauma. Of all trauma laparoscopies 29.3% were converted to open surgery (laparotomy). Among the non-converted laparoscopies 60.5% were therapeutic. Complications occurred after trauma laparoscopy in 8.6% of cases.

Conclusion

By means of systematic laparoscopic exploration, missed injuries in abdominal trauma are extremely rare, so that concerns in this respect no longer seem justified. A large proportion of intra-abdominal injuries can be treated using laparoscopy or laparoscopically assisted procedures.

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Danksagung

Wir danken Herrn Prof. Dr. rer. nat. Peter Martus für die statistische Beratung und kritisch konstruktive Durchsicht des Manuskripts.

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Authors and Affiliations

  1. Universitätsklinik für Allgemeine‑, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    Christian Beltzer, Robert Bachmann, Jens Strohäker, Steffen Axt & Alfred Königsrainer

  2. Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    Christian Beltzer & Roland Schmidt

  3. Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland

    Markus Küper

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  1. Christian Beltzer
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Correspondence to Christian Beltzer.

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Interessenkonflikt

C. Beltzer, R. Bachmann, J. Strohäker, S. Axt, R. Schmidt, M. Küper und A. Königsrainer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Beltzer, C., Bachmann, R., Strohäker, J. et al. Wertigkeit der Laparoskopie beim penetrierenden und stumpfen Abdominaltrauma – ein systematisches Review. Chirurg 91, 567–575 (2020). https://doi.org/10.1007/s00104-020-01158-y

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