• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Therapeutic Laparoscopy for Penetrating Anterior Abdominal Trauma; A safe Addition to the Diagnostic and Treatment Algorithm.

Salvatore Docimo, Jr., DO, MS, Alyssa Butt, BS, Vadim Meytes, Christopher Zambrano, Fausto Vinces, Michael Timoney, George Ferzli. Lutheran Medical Center

INTRODUCTION: The algorithm for the management of penetrating anterior abdominal injury (PAAI) is not clearly defined. The definitive diagnostic and therapeutic modality in penetrating anterior abdominal injury (PAAI) is exploratory laparotomy (EL), but it carries a morbidity and mortality up to 20% and 5%. Previous studies have shown that 30-50% of all stab wounds do not penetrate the peritoneum and the non-therapeutic laparotomy rate is as high as 70%. In an effort to reduce the morbidity associated with negative exploratory laparotomy, we retrospectively studied the use of laparoscopy as both a diagnostic tool, as well as a means of providing definitive therapy for PAAI in a Level I Trauma Center where the trauma surgeons have a high level of laparoscopic training. We also sought to determine if previous laparoscopic fellowship training and a low injury severity score (ISS) was associated with the use of laparoscopy in the treatment of PAAI.

METHODS AND PROCEDURES: We performed a retrospective review of trauma cases that underwent a DL at a Level I trauma center from 2008 to 2014. Inclusion criteria included all trauma patients who underwent diagnostic laparoscopy following PAAI. Exclusion criteria included: trauma patients above the below the age of 12, Glasgow Coma Scale (GSC) < 8, and hemodynamic instability. We divided our study group into patients who underwent: DL only, DL with conversion to EL (DL/EL), and DL with subsequent therapeutic laparoscopy (DL/TL). Endpoint outcomes were: missed injury, post-operative complications, length of stay (LOS), and avoidance of negative laparotomies.

RESULTS: Thirty patients with PAAI were included and underwent initial DL. Patients had an average: age of 30, BMI of 25.75, injury severity score (ISS) of 6.24 and, GCS of 15. FAST exam was performed in 18 (60%) patients with four (13.3%) having positive findings. No positive FAST exams were noted in DL group; 3 positive FAST exams were noted in the DL/TL group; and 1 positive FAST in the DL/EL group. The ISS of the DL, DL/TL, and DL/EL groups were 8.5, 11, and 12.28 (p=0.204; 95%CI). Nine (30%) cases required no intervention and remained DL. Fourteen (47%) cases underwent laparoscopic therapeutic intervention (hematoma evacuation, and visceral, mesentery, diaphgragm, or abdominal wall repair). Seven (23%) cases underwent conversion to EL. Average LOS for the DL, DL/TL, and DL/EL groups were 3.78, 2.5, and 6.28 days (p=0.044; 95%CI). Post-operative complications included one ileus in a DL case. No missed injuries in the DL or DL/TL groups were noted.

CONCLUSION:Therapeutic laparoscopy should be considered as an addition to the algorithm of management of PAAI. A trauma surgeon with advanced laparoscopic training may utilize laparoscopy, as both, a diagnostic and therapeutic modality for a subset of stable patients with PAAI. The difference in ISS for each group was not statistically significant and did not play a role in determining laparoscopic versus open therapies. In our study, laparoscopy in PAAI significantly decreased the incidence of negative laparotomy, avoided the complications associated with EL, and significantly decreased the hospital LOS.

157

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons