Role of Diagnostic Laparoscopy in the Evaluation of Blunt Injury to Abdomen in Hemodynamically Stable Patients

Abstract

BACKGROUND In this study, we wanted to evaluate the role of diagnostic laparoscopy in the management of blunt injury to abdomen in hemodynamically stable patients. METHODS This was a hospital based prospective observational clinical case study conducted among 30 patients who presented with blunt trauma of abdomen to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L.B. Nagar, Hyderabad, from September 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. The aim of the study is to assess the role of Diagnostic Laparoscopy in the management of Blunt Injury to Abdomen in Hemodynamically Stable patients. Objective of the study were to assess the incidence of Hollow Viscus Injury not detected by clinical or radiological assessment, incidence of persistent bleed and to assess the incidence of Mesentery injury not detected by clinical or radiological assessment. RESULTS The most common mode of injury was road traffic accidents (23 cases) 76.66 %, followed by fall from height (3 cases) 9.99 %. Then accidents and assaults which were (2 cases) 2.22 % each. Ongoing bleeding from solid organ injuries was seen intra-operatively in 3 cases (9.99 %). P value = 0.0237 was calculated using Fischer’s exact test and was found to be significant P < 0.05. Most common grade of liver injury was Grade 1- 37.75 % followed by grade 3 - 33.33 %, then grade 2 - 20.8 % and grade 4 - 8.33 %. Grade 1 and grade 2 splenic injuries were more common with 36.36 % (4 cases) each. Followed by grade 3 27.27 % (3 cases). Diagnostic laparoscopy ongoing bleed was noted in 9.99 % (3 cases), followed by mesenteric injury in 6.66 % (2 cases) and hollow viscous perforation in 3.33 % (1 case). Total of 6 therapeutic procedures were done after diagnostic laparoscopy. Out of which, 4 were carried out in laparoscopy (66.66 %) and two were converted from laparoscopy to laparotomy (33.33 %). CONCLUSIONS Diagnostic laparoscopy can be carried out in patients of blunt trauma of abdomen, who are hemodynamically stable without any increase in morbidity or mortality. It is a highly useful tool to detect injuries which could not be detected on CT scan. Laparoscopic surgery can be used both as a diagnostic and therapeutic modality. Laparoscopy helps in reducing the negative laparotomies and significant decrease in both morbidity and mortality. With advances in technology and increasing in expertise in laparoscopy, it can be concluded that diagnostic laparoscopy is a valuable modality in the diagnosis and management of patients with blunt trauma to abdomen.