Skip to main content

Advertisement

SpringerLink
Log in

Trauma laparoscopy: when to start and when to convert?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The use of laparoscopy for stable patients with abdominal trauma is increasing and its accuracy is nearly 100%. However, indications for laparoscopy and for conversion differ among centers. The aim of this study was to investigate indications for trauma laparoscopy and for conversion to laparotomy.

Methods

All trauma patients managed with laparoscopy over a 4-year period were retrospectively analyzed. Indications for laparoscopy, morbidity, and reasons for conversion were investigated and predictors of morbidity and conversion were sought. The management algorithm of trauma patients was reviewed and updated.

Results

Laparoscopy was used in 318 stable trauma patients. Thirty-five patients presented with blunt and 283 with penetrating abdominal injuries. The conversion rate was 11.7% for penetrating and 22.9% for blunt abdominal trauma patients. The most common reason for conversion was continuous intraabdominal bleeding that could not be controlled quickly. It was followed by multiple complex injuries, hemodynamic instability, and intraoperative visualization problems. Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases. There were no missed injuries. Complications occurred in 21.2% in the converted group and in 9.6% in the laparoscopic group. Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH was associated with conversion.

Conclusion

The management of all stable trauma patients with laparoscopy appears to be a safe approach. The use of sound laparoscopic equipment by a well-coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Continuous intraoperative bleeding, complexity of injuries, deterioration of the patient, poor visibility, and equipment failure are indications for conversion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ivatury RR, Simon RJ, Stahl WM (1993) A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 34:822–828. doi:10.1097/00005373-199306000-00013

    Article  CAS  PubMed  Google Scholar 

  2. Leppäniemi A, Haapiainen R (2003) Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study. J Trauma 55:636–645. doi:10.1097/01.TA.0000063000.05274.A4

    Article  PubMed  Google Scholar 

  3. Kawahara NT, Alster C, Fujimura I, Poggetti RS, Birolini D (2009) Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 67:589–595. doi:10.1097/TA.0b013e3181a60593

    Article  PubMed  Google Scholar 

  4. O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR (2013) Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg 37:113–122. doi:10.1007/s00268-012-1790-y

    Article  PubMed  Google Scholar 

  5. Hajibandeh S, Hajibandeh S, Gumber AO, Wong CS, Shih HC, Wen YS, Ko TJ, Wu JK, Su CH, Lee CH, Ertekin C, Yanar H, Taviloglu K, Guloglu R, Alimoglu O, Arikan S, Kocakusak A, Yucel AF, Adas G, Petras D, Lavora J, Taner AS, Topgul K, Kucukel F, Demir A, Sari S, Pinedo-Onofre JA, Guevara-Torres L, Sanchez-Aguilar JM, Leppaniemi AK, Voutilainen PE, Haapiainen RK, Gonzales RP, Turk B, Falimirski ME, Holevar MR, O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR, Kawahara NT, Alster C, Fujimura I, Poggetti RS, Birolini D, Li Y, Xiang Y, Wu N, Wu L, Yu Z, Zhang M, Al E, Birindelli A, Di Saverio S, Agresta F, Mandrioli M, Tugnoli G, Chestovich PJ, Browder TD, Morrissey SL, Fraser DR, Ingalls NK, Fildes JJ, Karateke F, Özdoğan M, Özyazıcı S, Daş K, Menekşe E, Gülnerman YC, Al E, Lin HF, Wu JM, Tu CC, Chen HA, Shih HC, Cherkasov M, Sitnikov V, Sarkisysn B, Degtirev O, Turbin M, Yakuba A, Miles EJ, Dunn E, Howard D, Mangram A, Leppaniemi A, Happianen R, DeMaria EJ, Dalton JM, Gore DC, Kellum JM, Sugerman HJ, Mutter D, Nord M, Vix M, Evrard S, Marescaux J, Marks JM, Youngelman DF, Berk T, Zantut LF, Ivatury RR, Smith RS, Kawahara NT, Porter JM, Fry WR, Al E, Smith RS, Fry WR, Morabito DJ, Koehler RH, Organ CH, Henderson VJ, Organ CH, Smith RS, Petersen SR, Sheldon GF, Villavicencio RT, Aucar JA, Lim KH, Chung BS, Kim JY, Kim SS, Khubutiya MS (2016) Laparoscopy vs. laparotomy for the management of penetrating abdominal trauma: a systematic review and meta-analysis. Int J Surg 34:127–136. doi:10.1016/j.ijsu.2016.08.524

    Article  PubMed  Google Scholar 

  6. Lin HF, Wu JM, Tu CC, Chen HA, Shih HC (2010) Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg 34:1653–1662. doi:10.1007/s00268-010-0485-5

    Article  PubMed  Google Scholar 

  7. Li T, Robertson-More C, Maclean AR, Dixon E, Navsaria P, Nicol AJ, Kirkpatrick AW, Ball CG (2015) Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: a retrospective population-based analysis. J Trauma Acute Care Surg 79:386–392. doi:10.1097/TA.0000000000000765

    Article  PubMed  Google Scholar 

  8. Koto MZ, Matsevych OY, Motilall SR (2015) The role of laparoscopy in penetrating abdominal trauma: our initial experience. J Laparoendosc Adv Surg Tech 25:730–736. doi:10.1089/lap.2015.0042

    Article  Google Scholar 

  9. Koto MZ, Matsevych OY, Aldous C (2016) Laparoscopic-assisted approach for penetrating abdominal trauma: an underutilized technique. J Laparoendosc Adv Surg Tech. doi:10.1089/lap.2016.0368

    Google Scholar 

  10. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications. Ann Surg 250:187–196. doi:10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  11. Matsevych OY, Koto MZ, Motilall SR, Kumar N (2016) The role of laparoscopy in management of stable patients with penetrating abdominal trauma and organ evisceration. J Trauma Acute Care Surg 81:307–311. doi:10.1097/TA.0000000000001064

    Article  PubMed  Google Scholar 

  12. Lin HF, Da Chen Y, Lin KL, Wu MC, Wu CY, Chen SC (2014) Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries. Am J Surg 210:326–333. doi:10.1016/j.amjsurg.2014.11.009

    Article  Google Scholar 

  13. Uranues S, Popa DE, Diaconescu B, Schrittwieser R (2015) Laparoscopy in penetrating abdominal trauma. World J Surg 39:1381–1388. doi:10.1007/s00268-014-2904-5

    Article  PubMed  Google Scholar 

  14. Chestovich PJ, Browder TD, Morrissey SL, Fraser DR, Ingalls NK, Fildes JJ (2015) Minimally invasive is maximally effective: diagnostic and therapeutic laparoscopy for penetrating abdominal injuries. J Trauma Acute Care Surg 78(6):1076–1083. doi:10.1097/TA.0000000000000655

    Article  PubMed  Google Scholar 

  15. Shih HC, Wen YS, Ko TJ, Wu JK, Su CH, Lee CH (1999) Noninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy. World J Surg 23:265–270. doi:10.1007/PL00013178

    Article  CAS  PubMed  Google Scholar 

  16. Brown JB, Gestring ML, Forsythe RM, Stassen NA, Billiar TR, Peitzman AB, Sperry JL (2015) Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90. J Trauma Acute Care Surg 78:352–359. doi:10.1097/TA.0000000000000523

    Article  PubMed  PubMed Central  Google Scholar 

  17. Clarke DL, Brysiewicz P, Sartorius B, Bruce JL, Laing GL (2017) Hypotension of ≤110 mmHg is associated with increased mortality in South African patients after trauma. Scand J Surg. doi:10.1177/1457496916680129

    Google Scholar 

  18. Lim KH, Chung BS, Kim JY, Kim SS (2015) Laparoscopic surgery in abdominal trauma: a single center review of a 7-year experience. World J Emerg Surg 10:16. doi:10.1186/s13017-015-0007-8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Biffl WL, Leppaniemi A (2015) Management guidelines for penetrating abdominal trauma. World J Surg 39:1373–1380. doi:10.1007/s00268-014-2793-7

    Article  PubMed  Google Scholar 

  20. Karateke F, Özdoğan M, Özyazıcı S, Daş K, Menekşe E, Gülnerman YC, Bali I, Önel S, Gökler C (2013) The management of penetrating abdominal trauma by diagnostic laparoscopy: a prospective non-randomized study. Turk J Trauma Emerg Surg 19:53–57. doi:10.5505/tjtes.2013.40799

    Article  Google Scholar 

  21. Sumislawski JJ, Zarzaur BL, Paulus EM, Sharpe JP, Savage SA, Nawaf CB, Croce MA, Fabian TC (2013) Diagnostic laparoscopy after anterior abdominal stab wounds: worth another look? J Trauma Acute Care Surg 75:1013–1018. doi:10.1097/TA.0b013e3182a1fde8

    Article  PubMed  Google Scholar 

  22. Shah M, Galante JM, Scherer LA, Utter GH (2014) The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds. Injury 45:128–133. doi:10.1016/j.injury.2013.08.015

    Article  PubMed  Google Scholar 

  23. Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, Elterman J, Moore EE (2011) Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 71:1494–1502. doi:10.1097/TA.0b013e31823ba1de

    PubMed  Google Scholar 

  24. El-Bendary YBA, Al-Adawi J, Al-Qadhi H (2016) The use of laparoscopy in the management of trauma patients: brief review. Sultan Qaboos Univ Med J 16:e9–e14. doi:10.18295/squmj.2016.16.01.003

    Article  PubMed  PubMed Central  Google Scholar 

  25. Choi YB, Lim KS (2003) Therapeutic laparoscopy for abdominal trauma. Surg Endosc Other Interv Tech 17:421–427. doi:10.1007/s00464-002-8808-8

    Google Scholar 

  26. Kong VY, Oosthuizen GV, Clarke DL (2015) The spectrum of injuries resulting from posterior abdominal stab wounds: a South African experience. Ann R Coll Surg Engl 97:269–273. doi:10.1308/003588415X14181254789204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL, Seamon MJ, Lin MJ, Mao M, Cipolla J, El Chaar M, Scantling D, Martin ND, Evans DC, Papadimos TJ, Stawicki SP (2015) Laparoscopy in trauma: an overview of complications and related topics. Int J Crit Illn Inj Sci 5:196–205. doi:10.4103/2229-5151.165004

    Article  PubMed  PubMed Central  Google Scholar 

  28. Este-McDonald JR, Josephs LG, Birkett DH, Hirsch EF (1995) Changes in intracranial pressure associated with apneumic retractors. Arch Surg 130:362–366. doi:10.1001/archsurg.1995.01430040024002

    Article  CAS  PubMed  Google Scholar 

  29. Cheddie S, Muckart DJJ, Hardcastle TC (2013) Base deficit as an early marker of coagulopathy in trauma. S Afr J Surg 51:88–90. doi:10.7196/SAJS.1665

    Article  PubMed  Google Scholar 

  30. Haider AA, Azim A, Rhee P, Kulvatunyou N, Ibraheem K, Tang A, OʼKeeffe T, Iftikhar H, Vercruysse G, Joseph B (2016) Substituting systolic blood pressure with shock index in the national trauma triage protocol. J Trauma Acute Care Surg 81:1. doi:10.1097/TA.0000000000001205

    Article  Google Scholar 

  31. Kwak HJ, Jo YY, Lee KC, Kim YB, Shinn HK, Kim JY (2010) Acid-base alterations during laparoscopic abdominal surgery: a comparison with laparotomy. Br J Anaesth 105:442–447. doi:10.1093/bja/aeq185

    Article  CAS  PubMed  Google Scholar 

  32. Grushka J, Ginzburg E (2014) Through the 10-mm looking glass: advances in minimally invasive surgery in trauma. Scand J Surg 103:143–148. doi:10.1177/1457496914523414

    Article  CAS  PubMed  Google Scholar 

  33. Zafar SN, Onwugbufor MT, Hughes K, Greene WR, Cornwell EE, Fullum TM, Tran DD (2015) Laparoscopic surgery for trauma: the realm of therapeutic management. Am J Surg 209:627–632. doi:10.1016/j.amjsurg.2014.12.011

    Article  PubMed  Google Scholar 

  34. Cherkasov M, Sitnikov V, Sarkisyan B, Degtirev O, Turbin M, Yakuba A (2008) Laparoscopy vs. laparotomy in management of abdominal trauma. Surg Endosc Other Interv Tech 22:228–231. doi:10.1007/s00464-007-9550-z

    Article  Google Scholar 

  35. Li Y, Xiang Y, Wu N, Wu L, Yu Z, Zhang M, Wang M, Jiang J, Li Y (2016) A comparison of laparoscopy and laparotomy for the management of abdominal trauma: a systematic review and meta-analysis. World J Surg 39:2862–2871. doi:10.1007/s00268-015-3212-4

    Article  Google Scholar 

  36. Pecorelli N, Greco M, Amodeo S, Braga M (2017) Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 31:85–99. doi:10.1007/s00464-016-4995-6

    Article  PubMed  Google Scholar 

  37. Smolarek S, Shalaby M, Paolo Angelucci G, Missori G, Capuano I, Franceschilli L, Quaresima S, Di Lorenzo N, Sileri P (2016) Small-bowel obstruction secondary to adhesions after open or laparoscopic colorectal surgery. J Soc Laparoendosc Surg 20(e2016):00073. doi:10.4293/JSLS.2016.00073

    Google Scholar 

  38. Crawshaw BP, Chien H-L, Augestad KM, Delaney CP (2015) Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy. JAMA Surg 150:410–415. doi:10.1001/jamasurg.2014.3171

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, P.O. Box 231, Pretoria, 0204, South Africa

    Oleh Matsevych, Modise Koto & Moses Balabyeki

  2. University of KwaZulu – Natal, Nelson R Mandela (NRMSM) Campus, Durban, South Africa

    Oleh Matsevych, Modise Koto & Colleen Aldous

Authors
  1. Oleh Matsevych
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Modise Koto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moses Balabyeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colleen Aldous
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oleh Matsevych.

Ethics declarations

Disclosures

Oleh Matsevych, Modise Koto, Moses Balabyeki, and Colleen Aldous have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsevych, O., Koto, M., Balabyeki, M. et al. Trauma laparoscopy: when to start and when to convert?. Surg Endosc 32, 1344–1352 (2018). https://doi.org/10.1007/s00464-017-5812-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5812-6

Keywords

Search

Navigation