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Surgical Endoscopy

, Volume 32, Issue 3, pp 1344–1352 | Cite as

Trauma laparoscopy: when to start and when to convert?

  • Oleh Matsevych
  • Modise Koto
  • Moses Balabyeki
  • Colleen Aldous
Article

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.

Keywords

Trauma Laparoscopy Indication Conversion Therapeutic laparoscopy Trauma laparoscopy 

Notes

Compliance with ethical standards

Disclosures

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

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Oleh Matsevych
    • 1
    • 2
  • Modise Koto
    • 1
    • 2
  • Moses Balabyeki
    • 1
  • Colleen Aldous
    • 2
  1. 1.Department of Surgery, Dr George Mukhari Academic HospitalSefako Makgatho Health Sciences UniversityPretoriaSouth Africa
  2. 2.University of KwaZulu – NatalDurbanSouth Africa

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