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Characteristics of Laparoscopic Surgery for Trauma Patients and Risks of Conversion to Open Laparotomy

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Abstract

Background

The discussion is ongoing about appropriate indications for laparoscopic surgery in trauma patients. As timing and risks of conversion to laparotomy remain unclear, we aimed to elucidate characteristics of and risks for conversion following laparoscopic surgery, using a nationwide database.

Methods

A retrospective observational study was conducted, using Japanese Trauma Data Bank (2004–2018). We included adult trauma patients who underwent laparoscopic surgery as an initial surgical intervention. Conversion to laparotomy was defined as laparotomy at the initial surgery. Patient demographics, mechanism and severity of injury, injured organs, timing of surgery, and clinical outcomes were compared between patients with and without conversion. Risks for conversion were analyzed focusing on indications for laparoscopic surgery, after adjusting patient and institution characteristics.

Results

Among 444 patients eligible for the study, 31 required conversions to laparotomy. The number of laparoscopic surgeries gradually increased over the study period (0.5–4.5% of trauma laparotomy), without changes in conversion rates (5–10%). Patients who underwent conversion had more severe abdominal injuries compared with those who did not (AIS 3 vs 2). While length of hospital stay and in-hospital mortality were comparable, abdominal complications were higher among patients with conversion (12.9 vs. 2.9%), particularly when laparoscopy was performed for peritonitis (OR, 22.08 [5.11–95.39]). A generalized estimating equation model adjusted patient background and identified hemoperitoneum and peritoneal penetration as risks for conversion (OR, 24.07 [7.35–78.75] and 8.26 [1.20– 56.75], respectively).

Conclusions

Trauma laparoscopy for hemoperitoneum and peritoneal penetration were associated with higher incidence of conversion to open laparotomy.

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Data availability

The data of this study are available from the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine.

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Acknowledgements

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Funding

No funding support in this study.

Author information

Authors and Affiliations

  1. Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Ryo Yamamoto

  2. Department of Surgery, UT Health San Antonio, San Antonio, TX, USA

    Ramon F. Cestero

  3. Department of Digestive Surgery, KKR Tachikawa Hospital, Tokyo, Japan

    Noriaki Kameyama

  4. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan

    Junichi Sasaki

Authors
  1. Ryo Yamamoto
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  2. Ramon F. Cestero
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  3. Noriaki Kameyama
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  4. Junichi Sasaki
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Contributions

RY and RC designed the study. RY performed data collection. JS managed quality control. RY and RC did data analysis and data interpretation. RY, RC, and JS did writing and critical revision. All author revised the manuscript.

Corresponding author

Correspondence to Ryo Yamamoto.

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Conflicts of interest

The authors have no relevant conflicts of interest to disclose.

Ethical approval

This study was approved by the Institutional Review Board of the Keio University School of Medicine (application number: 20090087). The requirement for informed consent was waived because of the anonymous nature of the data being used.

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Yamamoto, R., Cestero, R.F., Kameyama, N. et al. Characteristics of Laparoscopic Surgery for Trauma Patients and Risks of Conversion to Open Laparotomy. World J Surg 46, 2616–2624 (2022). https://doi.org/10.1007/s00268-022-06714-7

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  • DOI: https://doi.org/10.1007/s00268-022-06714-7

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