Vadim Meytes, DO, Grace Chang, Kevin Bain, DO, Michael Timoney, MD. NYU Langone Hospital – Brooklyn
Introduction: Diagnostic laparoscopy (DL) is an increasingly used modality when approaching penetrating anterior abdominal injury (PAAI). Historically, exploratory laparotomy (EL) for PAAI can result in a 20% negative laparotomy, 5% mortality and 20% morbidity rate. Laparoscopically trained trauma surgeons can utilize a minimally invasive technique to quickly assess for intra-abdominal organ injury in hemodynamically stable patients. In the hands of a skilled surgeon, PAAI with a confirmed injury can be repaired through therapeutic laparoscopy (TL) or EL without delay in treatment. This study analyzes the safety and efficacy of using DL as a first line therapy for hemodynamically stable patients with PAAI.
Methods: Between December 2006 and September 2016, 56 patients underwent DL after presenting to NYU Langone Hospital – Brooklyn Emergency Room with PAAI. A retrospective analysis was conducted to analyze protocol and treatment outcomes. Variables reviewed included Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), FAST exam and/or CT scan results, length of stay (LOS), and postoperative complications. Based on outcomes, patients were categorized into three groups: DL, DL with progression to TL, and DL with conversion to EL.
Results: In the study period, a total of 94 patients presented with PAAI that went to the OR, 56 of which were initially treated laparoscopically. Causes of injury included stab wounds, gunshot wounds, traffic accidents, and self-inflicted injuries. The mean age was 40 ± 12 years. The mean GCS was 14 ± 2, and the mean ISS was 4 ± 4. Of the 56 patients who underwent DL, 25 patients (44.6%) required no further intervention (group 1), 21 patients (37.5%) underwent TL (group 2), and 10 patients (17.8%) required EL (group 3). Mean LOS for groups 1, 2 and 3 were 4 ± 3.3 days, 3 ± 1.9 days and 6 ± 4.5 days, respectively. There were no missed injuries or postoperative complications requiring the OR in all groups. TL included diaphragm laceration repairs, control of hepatic laceration and primary bowel repair.
Conclusion: Diagnostic Laparoscopy should be considered first line for hemodynamically stable patients with PAAI with equivocal FAST and/or CT scan findings. Eighty-two percent of our patients did not require conversion to EL. This allowed for decreased postoperative pain, quicker recovery time, and shorter hospital stays. When in the hands of laparoscopically trained trauma surgeons, these patients can be quickly and safely treated while avoiding any delays in diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87420
Program Number: S069
Presentation Session: Acute Care Session
Presentation Type: Podium