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Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases

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Abstract

Background

Trauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients.

Methods

We performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann–Whitney and Kruskal–Wallis test.

Results

We evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach.

Conclusion

In selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications.

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Funding

No funding sources were associated with this study.

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Authors and Affiliations

  1. Division of General Surgery and Trauma, Department of Surgery, University of São Paulo, Av. Enéas de Carvalho de Aguiar, 255, Cerqueira César, São Paulo, SP, Brazil

    Carlos Augusto Metidieri Menegozzo, Sérgio Henrique Bastos Damous, Guilherme Rissato Sabioni, Pedro Henrique Ferreira Alves, Roberto Rasslan, Francisco de Salles Collet e Silva & Edivaldo Massazo Utiyama

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  1. Carlos Augusto Metidieri Menegozzo
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  2. Sérgio Henrique Bastos Damous
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  3. Guilherme Rissato Sabioni
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  4. Pedro Henrique Ferreira Alves
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  5. Roberto Rasslan
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  6. Francisco de Salles Collet e Silva
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  7. Edivaldo Massazo Utiyama
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Contributions

CAMM: study design, literature search, data collection, manuscript writing, data interpretation. SHBD: study design, manuscript writing, data interpretation. GRS: data collection. PHFA: study design, data interpretaon. RR: manuscript writing, data interpretation. FSCS: data collection, critical revision. EMU: data interpretation, critical revision.

Corresponding author

Correspondence to Carlos Augusto Metidieri Menegozzo.

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Disclosures

Dr Carlos Augusto Metidieri Menegozzo, Dr Sérgio Henrique Bastos Damous, Dr Guilherme Rissato Sabioni, Dr Pedro Henrique Ferreira Alves, Dr Roberto Rasslan, Prof Francisco de Salles Collet e Silva, and Prof. Edivaldo Massazo Utiyama have no conflict of interests to disclose.

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Menegozzo, C.M., Damous, S.B., Sabioni, G.R. et al. Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases. Surg Endosc 37, 6727–6735 (2023). https://doi.org/10.1007/s00464-023-10121-x

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