Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose?
Background: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asympt...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2019-01-01
|
| Series: | Journal of Minimal Access Surgery |
| Subjects: | |
| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2019;volume=15;issue=2;spage=130;epage=136;aulast=Matsevych |
| _version_ | 1811227012560322560 |
|---|---|
| author | Oleh Yevhenovych Matsevych Modise Zacharia Koto Moses Balabyeki Lehlogonolo David Mashego Colleen Aldous |
| author_facet | Oleh Yevhenovych Matsevych Modise Zacharia Koto Moses Balabyeki Lehlogonolo David Mashego Colleen Aldous |
| author_sort | Oleh Yevhenovych Matsevych |
| collection | DOAJ |
| description | Background: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL.
Methods: Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes.
Results: Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality.
Conclusion: NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies. |
| first_indexed | 2024-04-12T09:35:18Z |
| format | Article |
| id | doaj.art-1a5ab512edad4e3699104198742c6b41 |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-04-12T09:35:18Z |
| publishDate | 2019-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-1a5ab512edad4e3699104198742c6b412022-12-22T03:38:15ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212019-01-0115213013610.4103/jmas.JMAS_72_18Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose?Oleh Yevhenovych MatsevychModise Zacharia KotoMoses BalabyekiLehlogonolo David MashegoColleen AldousBackground: Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL. Methods: Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes. Results: Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality. Conclusion: NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2019;volume=15;issue=2;spage=130;epage=136;aulast=MatsevychDiagnostic laparoscopylaparoscopynon-operative managementtrauma |
| spellingShingle | Oleh Yevhenovych Matsevych Modise Zacharia Koto Moses Balabyeki Lehlogonolo David Mashego Colleen Aldous Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? Journal of Minimal Access Surgery Diagnostic laparoscopy laparoscopy non-operative management trauma |
| title | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
| title_full | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
| title_fullStr | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
| title_full_unstemmed | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
| title_short | Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose? |
| title_sort | diagnostic laparoscopy or selective non operative management for stable patients with penetrating abdominal trauma what to choose |
| topic | Diagnostic laparoscopy laparoscopy non-operative management trauma |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2019;volume=15;issue=2;spage=130;epage=136;aulast=Matsevych |
| work_keys_str_mv | AT olehyevhenovychmatsevych diagnosticlaparoscopyorselectivenonoperativemanagementforstablepatientswithpenetratingabdominaltraumawhattochoose AT modisezachariakoto diagnosticlaparoscopyorselectivenonoperativemanagementforstablepatientswithpenetratingabdominaltraumawhattochoose AT mosesbalabyeki diagnosticlaparoscopyorselectivenonoperativemanagementforstablepatientswithpenetratingabdominaltraumawhattochoose AT lehlogonolodavidmashego diagnosticlaparoscopyorselectivenonoperativemanagementforstablepatientswithpenetratingabdominaltraumawhattochoose AT colleenaldous diagnosticlaparoscopyorselectivenonoperativemanagementforstablepatientswithpenetratingabdominaltraumawhattochoose |