Increasing Use of Exploratory Laparoscopy at a Level I Trauma Center: Impact on Negative Laparotomy Rate

Nova Szoka, MD, Patrick McGrew, MD, Barkat Ali, MD, Krista Turner, MD, Stephen Lu, MD, Edward D Auyang, MD. University of New Mexico Department of General Surgery.

INTRODUCTION – Exploratory laparoscopy for evaluating stable trauma patients for intraperitoneal injury has seen increased usage in recent years. We hypothesized that the use of laparoscopy for trauma at our Level I Trauma Center has been increasing for both blunt and penetrating injuries, and might influence the number of negative laparotomies performed.

METHODS AND PROCEDURES – We performed a retrospective review of all patients with documented blunt or penetrating trauma at the University of New Mexico Hospital (UNMH) from January 1, 2012 to September 25, 2013. Mechanism of trauma, type of operative intervention, and length of hospital stay were examined.

RESULTS – In 2012, exploratory laparoscopy was performed in 9 patients, with 5 patients requiring conversion to an open operation based on intraoperative findings. In 2013, exploratory laparoscopy was performed in 17 patients, with 7 patients converting to open. Of the 26 laparoscopies, 22 were for penetrating and 4 were for blunt injuries. Exploratory laparoscopy was used to rule out peritoneal penetration (9/26 cases), diaphragmatic injury (7/26 cases), or to identify hemoperitoneum (5/26 cases). In the same time period, 236 exploratory laparotomies were performed. Between 2012 and 2013, the use of laparoscopy increased from 9 to 17 operations, and the number of negative laparotomies decreased from 21 to 6 operations.

CONCLUSION – The use of exploratory laparoscopy for diagnosis and treatment of blunt and penetrating trauma is increasing at UNMH; there is a concurrent decrease in the rate of negative laparotomies. The main use of the laparoscopic approach was for evaluating for peritoneal penetration, diaphragmatic injury, or hemoperitoneum.

 

 

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