Basic Operative Techniques in Abdominal Injury

Abstract

The abdomen is the third most affected region in blunt trauma, and major traumatic injury may not be recognized quickly enough. The authors present their preferred treatment and access for most common types of abdominal organ injury. Lower thoracic and upper abdominal trauma should be considered as a unit, and any penetrating wound below the level of the nipple should be suspected as an abdominal injury. Thanks to many technological developments, the surgical management of significantly injured trauma patients has gone through a major change over the last decade, and the basic principles of the contemporary approach include different therapeutic strategies from damage control operations to damage control resuscitation and appropriate utilization of adjunctive bleeding control strategies. The emergency laparotomy includes tasks and strategies that are drastically different than the elective laparotomy. A longer operation has little effect on the outcome of a patient who is physiologically stable. However, every intraoperative minute is important on those patients in metabolic failure and haemodynamic collapse. Selective nonoperative management of significant abdominal injuries has represented one of the most important changes in the trauma patient care over the last decades. Angiographic embolization has also become an indispensable tool for control of the bleeding abdominal injuries. Open operative procedures are increasingly changing towards a minimally invasive approach as newer equipment and surgeon technical skills advance. In addition to advances in solid organ injury treatment, vascular injuries are also being managed with minimally invasive endovascular techniques.