ABSTRACT

Aim: Mandatory urgent explorative laparotomy as a role and standard procedure for managing blunt versus abdominal penetrating wounds carry a significant percentage of negative laparotomies in the absence of visceral injuries. Debate remains regarding the optimum role of laparoscopy in the setting of trauma although it can offer advantages over traditional exploratory laparotomy. Laparoscopy can be a screening, diagnostic or therapeutic tool in trauma. Laparoscopy is a unique diagnostic procedure inspecting the peritoneum for signs of perforation and excluding significant intra-abdominal injuries.

Methods: A prospective study included 118 patients with abdominal trauma in haemodynamically stable patients, done in 2 institutes. 70 patients with blunt trauma and 48 patients with penetrating trauma. Patients were assigned into two groups, group A underwent laparoscopic exploration of the abdomen (61 Patients) and group B undergo exploratory laparotomy (57 patients).

Results: 118 patients with abdominal trauma in hemodynamically stable patients, 70 patients with blunt trauma and 48 patients with penetrating trauma. There was a significant difference between both groups regarding postoperative complication, in laparotomy group 10 patients developed postoperative complications, four with postoperative ileus, one with pneumonia and other five with wound infections in laparoscopy group and only one patient developed postoperative ileus and this was statistically different between both groups, Significant P-value 0.009 and Odd ratio 6.277 and (95CI %) (1.311 – 30.043. Hospital stay was less in laparoscopy group (P-value<0.001). Negative or non-therapeutic laparotomy accounts for 15 patients (41.7%) from 36 patients with no intervention done.

Conclusion: Not all patients with abdominal trauma are the candidate for laparoscopy. It is particularly diagnostic and therapeutic and avoids negative laparotomies.