Selective application of laparoscopic intervention in the management of isolated bowel rupture in blunt abdominal trauma.

BACKGROUND

Recently, laparoscopy has been used as an effective diagnostic and therapeutic modality for traumatic injury and peritonitis. However, its clinical benefits are still under evaluation. The aim of this study was to assess the feasibility and safety of this technique, in comparison with traditional laparotomy, in the management of isolated bowel rupture. A further aim was to evaluate possible predictive clinical factors in the management of isolated bowel rupture.

INDICATIONS

Patients with definite or suspected isolated gastrointestinal perforation who were hemodynamically stable underwent laparoscopic surgery for diagnosis and treatment.

METHODS AND RESULTS

The traditional laparotomy control group (Group A, historical controls) included patients from a prior study. In this previous study, carried out between 1993 and 1997, 23 consecutive cases of traumatic gastrointestinal perforation were treated with traditional laparotomy. Retrospectively, 13 of these 23 cases would have been eligible for laparoscopic intervention. The laparoscopic group (group B) was made up of cases seen at our institution from 1998 to 2000. Of the 13 consecutive cases of traumatic gastrointestinal perforation, only one required immediate traditional laparotomy. Just one of the 12 cases of gastrointestinal perforation approached laparoscopically had to be converted to a traditional laparotomy. The following variables were evaluated in both groups: patient background, time from accident to onset of operation, operative time, blood loss, time to oral intake, incidence of peritoneal contamination, length of hospital stay, mortality, and intraoperative and postoperative complications. There were no statistical differences in age, gender ratio, and injury severity score (ISS). The mean operative times were 132.3 +/- 58.7 minutes and 143.6 +/- 27.3 minutes in group A and group B, respectively. The mean blood loss was 266.8 +/- 277.8 mL in group A and 57.6 +/- 57.1 mL in group B. The blood loss in group B was significantly lower (P =.0084) than that in group A. There were no significant differences in intraoperative and postoperative complications, hospital stay, and mortality between the two groups.

CONCLUSIONS

Laparoscopic intervention offers better results in the management of patients with blunt abdominal trauma and isolated bowel rupture.