Jay N Collins, MD, Rebecca C Britt, MD, Leonard J Weireter, MD, L D Britt, MD MPH. Eastern Virginia Medical School
INTRODUCTION: To evaluate the safety and efficacy of diagnostic laparoscopy (DL) against non-therapeutic laparotomy (NTL) in the setting of acute abdominal or thoracoabdominal trauma.
METHODS: A retrospective analysis of adult trauma patients older than 16 years admitted from September 1, 2005 to August 31, 2011 was performed. Hemodynamically normal patients with suspicion for intraabdominal injury after blunt or penetrating injury underwent either exploratory laparotomy or diagnostic laparoscopy based on the attending surgeon’s preference. Patient demographics, hospital length of stay (LOS) and hospital complications were analyzed.
RESULTS: During the study period 7384 adult trauma patients, 5998 blunt and 1386 penetrating, were admitted. A total of 224 exploratory laparotomies were done of which 41 were non-therapeutic(NTL). DL was done in 40 patients. Twenty-three patients had no injury identified on diagnostic laparoscopy (NDL) and were soon discharged. Seventeen DL patients required repair of injuries, six done laparoscopically and 11 converted to open laparotomy for further evaluation and repair. Age (31.8 vs. 30.5), male gender (80% vs. 85%) and ISS (8.3 vs. 8.0) were similar in the NTL and DL groups. Blunt and penetrating injuries were seen in 6 and 34 of NTL and in 12 and 27 of DL patients. Mean hospital LOS was 1.8 days in NDL and 5.0 days in NTL patients (p = 0.01). Three complications, one subcutaneous abscess, one retained hemothorax and urinary retention, occurred in three NDL patients. NTL patients sustained 23 complications including ileus (12), wound infection (3), urinary tract infection (2), pneumonia, C. Difficile colits, respiratory failure requiring reintubation, splenectomy, atrial fibrillation and retained foreign body. No NDL patient had missed injuries or required re-exploration for a negative predictive value of 100%. Fifty-eight percent (23/40) DL patients safely avoided NTL. There were no deaths in either group.
CONCLUSION: In the evaluation of acute abdominal trauma with the hemodynamically normal patient, diagnostic laparoscopy is safer and allows for earlier discharge than NTL when abdominal injuries are not present. This will result in significant cost savings. Non-therapeutic laparotomy is associated with more significant complications and much longer LOS than DL.
Session Number: SS04 – Quality Outcomes
Program Number: S021