ABSTRACT
La evaluación y el manejo del trauma abdominal ha presentado cambios significativos en los últimos tiempos. La laparoscopia en el trauma abdominal penetrante ha sido de gran utilidad principalmente como método diagnóstico, sin embargo, se debería considerar como herramienta terapéutica.Objetivo: Determinar la eficacia del manejo laparoscópico vs el convencional en el tratamiento de pacientes con trauma abdominal penetrante por heridas de arma blanca.Métodos : Estudio experimental, prospectivo, comparativo. La población de estudio estuvo representada por pacientes con diagnóstico de traumatismo abdominal penetrante por herida de arma blanca que ingresaron a la emergencia de cirugía del Hospital Dr. Miguel Pérez Carreño durante el periodo enero 2019 a julio 2021.Resultados : Fueron incluidos 48 pacientes, 28 pacientes del grupo control y 20 pacientes del grupo experimental. Ambos grupos fueron comparables con respecto a edad y sexo. El índice de severidad del trauma (PATI) fue similar en ambos grupos. Las complicaciones y el tiempo quirúrgico no tuvieron diferencias estadísticamente significativas. Las cirugías negativas representaron el 15 % en el grupo laparoscópico vs 11 % en el abordaje convencional. El porcentaje de conversión fue de 15 %. La estancia hospitalaria fue menor en el grupo laparoscópico 3,25 vs 4,6 días (p = 0,04).Conclusión: La cirugía laparoscópica puede considerarse el abordaje de elección en pacientes hemodinámicamente estables con trauma abdominal penetrante por herida de arma blanca, siendo un método seguro y eficaz, brindando los beneficios propios de la cirugía mínimamente invasiva, con baja tasa de complicaciones y una recuperación más rápida(AU)
The evaluation and management of abdominal trauma have changed significantly in recent times. Laparoscopic approach in penetrating abdominal trauma has been useful as diagnostic method, however, its therapeutic value should be considered. Objective: To determine the efficacy of laparoscopy versus laparotomy approach as treatment in patients with penetrating abdominal trauma caused by stab wounds. Methods: We conducted an experimental, prospective and comparative study. Study population was represented by patients with diagnosis of penetrating abdominal trauma due to stab wounds who were admitted to the emergency room of Dr. Miguel Pérez Carreño Hospital between January 2019 and July 2021.Results : 48 patients were included, 28 in the control group and 20 patients in the experimental group. No differences were found between groups regarding age and sex. The penetrating abdominal trauma index (PATI) was similar in both groups. Differences in complications and surgical time were not statistically significant. Non-therapeutic surgeries represented 15 % in laparoscopic group and 11 % in laparotomy group. The conversion percentage was 15 %. Hospital stay were shorter in laparoscopic group, 3.25 vs 4.6 days (p = 0.04). Conclusion: Laparoscopic surgery can be considered the approach of choice in hemodynamically stable patients with penetrating abdominal trauma due to stab wounds. It is a safe and effective method, providing the benefits of minimally invasive surgery, with a low rate of complications and faster patient recovery(AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Wounds, Stab , Laparoscopy , Abdominal Injuries , Wounds and Injuries , Minimally Invasive Surgical Procedures , LaparotomyABSTRACT
Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.
ABSTRACT
Objective To investigate the preliminary experience of laparoscopic partial nephrectomy in patients with adherent perinephric fat. Methods We retrospectively analyzed the clinical data of 16 patients with adherent perinephric fat undergoing laparoscopic partial nephrectomy by the single surgeon in the Department of Urology of Changhai Hospital, Second Military Medical University between Jan. 2016 and Dec. 2016. For the patients with serious adherent perinephric fat, the tumor could be located by the intra-operative B-mode ultrasound after exposing the general boundaries of tumor and normal renal tissues, and the boundaries were marked with electric knife. The adherent adipose tissue and tumor were both resected with scissors along the marking line after blocking the blood flow. Results The operations were successfully completed in all the 16 patients, and the intra-operative B-mode ultrasound positioning was used in 5 cases. The maximal diameter of tumor was 2.1-3.5 (2.8±0.4) cm, the Mayo adhesive probability (MAP) score was 3-5 (3.8±0.7), the renal artery occlusion time was 20-31 (25.6±3.1) min, and the operation time was 90-133 (112.0±10.5) min. During a follow-up of 6-20 months, no patients had recurrence or metastasis. Conclusion It is important to locate the tumor boundaries during laparoscopic partial nephrectomy in patients with adherent perinephric fat, and the intra-operative B-mode ultrasound can be used if necessary. The tumor and adherent adipose tissue must be both resected to avoid forced separation of perirenal fat from renal capsule.
ABSTRACT
Objective To discuss the indications and complications of primary closure of bile duct incision in laparoscopic bile duct exploration and balloon dilatation catheter dilatation to treat the papillary stenosis and the intrahepatic bile duct stenosis. Methods A pospective study of 42 ptients of bile duct incision closure primary in laparoscopic bile duct exploration and balloon dilatation catheter dilatation, laparoscopic bile duct exploration and extraction of bile duct stones with choledochotomy was first adopted in order to clear the stones, then followed by the balloon dilatation catheter(explosive pressure reached 2020 kPa, used 505kPa) to dilate the papillary stenosis and the intrahepatic bile duct stenosis (CT-7542～ CT-75104) until the stenosis was released. Whether the primary closure of duct incision was selected or not, it was based on the situation of intraoperative choledochoscopic exploration, if it had been selected, the closure of bile duct incision would accepted by using absorbable suture 4-0 or 5-0, without placing bile duct drainage.It was routinely to place the drainage tube in the oriffice of the lesser omentum. Results 41 out of 42 patients had obtained successful duct clearance, the dilatation of the stenosis to reach the expected expansion and without bile leakage. One patient had bile leakage about 30-150 ml daily persisted for 4 days through cured conservatively. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilatation of the stenosis to reach the expected expansion with the balloon dilatation catheter. They were adopted to the primary closure of duct incision using absorbable suture and did not need to place bile duct drainage.