The Role of Laparoscopy in the Diagnosis and Treatment of Abdominal Trauma

Preventable laparotomy in patients with abdominal trauma who present with haemoperitoneum but with stable hemodynamics may be avoided if a diagnostic or therapeutic laparoscopy is performed. The assessment of a patient with abdominal trauma can be complicated by many factors, and the resultant inaccurate or delay in diagnosis has contributed to the unacceptable high mortality and morbidity for this type of injury. Diagnostic laparoscopy for the evaluation of injuries in patients with abdominal trauma has been shown to decrease the morbidity and mortality associated with mandatory laparotomy.The prognosis of abdominal trauma depends in most cases not only on the extent of existing injuries but also on prompt therapy. Thus, diagnostic measures have to clarify rapidly and accurately whether laparotomy has to be performed or not. Difficulties in decision for the surgeon arise especially in cases of abdominal trauma where diagnostic imaging (ultrasonography, CT scan) do not lead to clearcut results. The use of laparoscopy as a diagnostic method dates back to the first decades of this century. Laparoscopic surgical techniques were first used by gynecologists and later, in 1989, Dubois performed the first cholecystectomy using a laparoscopic approach. Since then, in the space of a few years, there has been an overwhelming spread of video laparoscopic operating methods, extending the therapeutic possibilities to gastroenterological surgery, as well as to thoracic, oncological, urological, and of course, gynecological surgery. The use of the laparoscope as a diagnostic method in abdominal trauma was proposed in the 70s by a number of authors, but only now, due to technological progress and the constant use of elective laparoscopic surgery, have surgeons been able to use this method for the diagnosis and treatment of patients with blunt or penetrating abdominal trauma. Rather than open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of traumatic abdominal injuries. The following study was undertaken to find out the role of minimal invasive surgery in the diagnosis and management of abdominal trauma.