Use of minimally invasive surgery for the management of hollow viscus traumatic injuries.

Autor: Litwin A; Baystate Medical Center, General Surgery, 26 Irvington St., Springfield, MA, 01108, USA. litwinandrew@gmail.com., Coulter AP; Baystate Medical Center, General Surgery, 26 Irvington St., Springfield, MA, 01108, USA., Romanelli J; Baystate Medical Center, General Surgery, 26 Irvington St., Springfield, MA, 01108, USA., Tirabassi M; Baystate Medical Center, General Surgery, 26 Irvington St., Springfield, MA, 01108, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Nov; Vol. 36 (11), pp. 8421-8429. Date of Electronic Publication: 2022 Feb 28.
DOI: 10.1007/s00464-022-09102-3
Abstrakt: Background: The objective of this study is to assess surgical outcomes following the initial use of laparoscopy versus laparotomy when managing patients with hollow viscus injuries due to trauma.
Methods: Using the database from the American College of Surgeons Trauma Quality Improvement Program we identified all patients from 2015-2017 with ICD-10 Diagnosis codes for hollow viscus trauma. Types of procedures were identified by ICD-10 PCS codes. Patient outcomes were stratified by major trauma(ISS > 15) and minor trauma. Continuous variables were compared by ANOVA and categorical variables compared by Chi-Square. Analysis performed using STATA 16.
Results: We identified 16,284 patients that matched inclusion criteria within the study time frame. Of those, 1986 patients received a surgical intervention, 1911(96%) were open and 75(4%) were laparoscopic. In blunt trauma there were 106 diagnostic procedures, 87(82%) were open and 19(18%) were laparoscopic. There were 574 therapeutic procedures, 543(95%) were open and 31(5%) were laparoscopic. In penetrating trauma there were 223 diagnostic procedures, 215(96%) were open and 8(4%) were laparoscopic. There were 1039 therapeutic procedures for penetrating trauma, 1023(98%) were open and 16(2%) were laparoscopic. For minor trauma, mean length of stay(days) after open surgery was 5 while for laparoscopy it was 2 (p = 0.04). There were 203 complications noted in the open group and 7 in the laparoscopic group (p = 0.19). For major trauma, mean length of stay(days) after open surgery was 5 and 6 for laparoscopy p = 0.54). There were 242 complications in the open group and 1 in the laparoscopic group (p = 0.07). There was no noted significant difference noted in the disposition at discharge in either group in both major and minor trauma.
Conclusions: For those that required surgery for hollow viscous injury, laparoscopy appeared to be safe, had less adverse outcomes and was underutilized, particularly when only a diagnostic procedure was required.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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