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Laparoscopy versus conventional laparotomy in the management of abdominal trauma: a multi-institutional matched-pair study

  • 2019 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopy is being increasingly applied as either a diagnostic or therapeutic intervention in the management of abdominal trauma. However, its outcomes in comparison with conventional laparotomy remain unclear, especially in terms of therapeutic management.

Methods

This retrospective cohort study included patients from three trauma centers in Beijing, China. Fifty-four patients undergoing laparoscopic interventions for abdominal trauma by experienced laparoscopists were enrolled in the laparoscopy group (LP group). Another 54 patients who underwent laparotomy (LT group) were matched according to the patients’ baseline characteristics, causes of injury, and hemodynamic parameters. Perioperative clinical parameters and short-term survival were compared between these two groups.

Results

The baseline characteristics were comparable between these two groups (LP vs. LT: Age, p = 0.112; Sex, p = 0.820; Injury severity score, p = 0.158; Cause distribution, p = 0.840). The most common cause was traffic accident (36.1%) and the most frequent surgical intervention was bowel repair/resection (34.3%) in our study. The operation time was similar in these two groups (LP vs. LT: 202.2 ± 72.58 vs. 194.11 ± 82.95 min, p = 0.295) while post-operative complication rate was slightly reduced in LP group (7.7% vs. 13.5%) with no statistical significance (p = 0.383). Opioid use was lower in the LP than LT group (11.67 ± 4.08 vs. 26.0 ± 13.42 morphine equivalents (MEQ), p = 0.034). The hospital stay was significantly shorter in the LP group (13.48 ± 10.9 vs. 18.64 ± 14.73 days, p = 0.021). One patient in the LT group died of an intra-abdominal abscess and multiple organ dysfunction syndrome 19 days postoperatively, while all patients in the LP group recovered and were discharged.

Conclusion

Laparoscopy is feasible and safe in treating abdominal trauma patients in hemodynamically stable conditions performed by experienced surgeons. Laparoscopy might have the advantages of reduced pain and quicker recovery with similarly favorable clinical outcomes.

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Acknowledgement

We thank for Dr. Angela Morben, from University of Minnesota for editing the English text of a revision of this manuscript.

Funding

This work was funded by the National Nature Science Foundation of China (Nos. 81672319, 81602507, 81773135), the grant from the Special Scientific Research Foundation of Health Sector of China (No. 201202016), Beijing Municipal Science and Technology Plan projects (Z161100000516237 and D141100000414002), Beijing Nova Program (No. Z181100006218011).

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Author notes

  1. Yunhe Gao, Shaoqing Li and Hongqing Xi have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Chinese People’s Liberation Army General Hospital, Fuxing Road 28, Beijing, 100853, People’s Republic of China

    Yunhe Gao, Shaoqing Li, Hongqing Xi, Kecheng Zhang, Jianxin Cui, Jiyang Li, Yi Liu, Yixun Lu, Baohua Wang, Zhi Qiao & Lin Chen

  2. Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, 100853, China

    Yunhe Gao, Shaoqing Li, Kecheng Zhang, Yi Liu, Yixun Lu, Baohua Wang & Lin Chen

  3. Department of General Surgery, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Shibo Bian

  4. Department of General Surgery, The First Affiliated Hospital of the PLA General Hospital (304 Hospital), Beijing, 100048, China

    Feide Liu

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  1. Yunhe Gao
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Correspondence to Zhi Qiao or Lin Chen.

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Disclosures

Drs. Yunhe Gao, Shaoqing Li, Hongqing Xi, Shibo Bian, Kecheng Zhang, Jianxin Cui, Jiyang Li, Feide Liu, Yi Liu, Yixun Lu, Baohua Wang and Profs. Zhi Qiao, Lin Chen have no conflict of interest or financial ties to disclose.

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Gao, Y., Li, S., Xi, H. et al. Laparoscopy versus conventional laparotomy in the management of abdominal trauma: a multi-institutional matched-pair study. Surg Endosc 34, 2237–2242 (2020). https://doi.org/10.1007/s00464-019-07013-4

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