Gómez Efrain J I, Vargas Luis F C, Lozada-Martinez Ivan D, Reyes Mariana, Pedraza Mauricio, Forero Nicolas, Guardo-Carmona Daniela, Narvaez-Rojas Alexis R
Department of General Surgery Universidad El Bosque Bogota Colombia.
Department of Vascular Surgery and Angiology Hospital Militar Central Bogota Colombia.
Health Sci Rep. 2022 May 24;5(3):e640. doi: 10.1002/hsr2.640. eCollection 2022 May.
Abdominal trauma is one of the leading causes of death. In Colombia, few studies have evaluated the results on related factors and outcomes when comparing laparotomy versus laparoscopy in the management of penetrating abdominal trauma. Therefore, the aim of this study was to investigate the feasibility and safety of laparoscopy in the treatment of stable penetrating abdominal trauma in a limited resources environment in a middle-income country.
Retrospective cross-sectional study was conducted in Bogota, Colombia from January 2018 to October 2020. Patients over 18 years old, hemodynamically stable with penetrating abdominal trauma without other body parts injuries, that underwent laparoscopy and/or laparotomy surgical exploration and treatment were included. Frequencies, percentages, correlations, and odds ratio were calculated.
A total of 52 patients were analyzed (26 laparoscopy vs. 26 laparotomy). Stabbing injuries were more frequent in both groups (76.9%), as well as involvement of the anterior abdomen. None missed enterotomies were reported in the laparoscopy group. Surgical time and bleeding were significantly lower in the laparoscopic approach group (63 vs. 115 min and 65 vs. 992 cc, respectively). The time to oral intake and length of stay in the intensive care unit was significantly shorter in the laparoscopic management group (2 vs. 3 days and 1 vs. 4 days, respectively).
Surgical results found a safe scenario in a limited resources environment for the application of the laparoscopic technique to approach penetrating abdominal trauma in stable patients without missed injuries, low threshold of conversion to open approach, and additionally not presenting a higher percentage of complications compared with the laparotomy group in Colombia. Operative time, oral intake, and length of hospital stay were lower in the fully therapeutic laparoscopy group.
腹部创伤是主要的死亡原因之一。在哥伦比亚，很少有研究评估在穿透性腹部创伤的治疗中，开腹手术与腹腔镜手术在相关因素和结果方面的对比。因此，本研究的目的是探讨在中等收入国家资源有限的环境下，腹腔镜手术治疗稳定型穿透性腹部创伤的可行性和安全性。
2018年1月至2020年10月在哥伦比亚波哥大进行了一项回顾性横断面研究。纳入年龄超过18岁、血流动力学稳定、有穿透性腹部创伤且无其他身体部位损伤、接受腹腔镜和/或开腹手术探查及治疗的患者。计算了频率、百分比、相关性和比值比。
共分析了52例患者（26例行腹腔镜手术，26例行开腹手术）。两组刺伤均更为常见（76.9%），且前腹部受累情况相似。腹腔镜手术组未报告漏诊的肠切开术。腹腔镜手术组的手术时间和出血量显著更低（分别为63分钟对115分钟和65毫升对992毫升）。腹腔镜治疗组的经口进食时间和重症监护病房住院时间显著更短（分别为2天对3天和1天对4天）。
手术结果表明，在资源有限的环境下，对于稳定型患者应用腹腔镜技术治疗穿透性腹部创伤是安全的，无漏诊损伤，转为开放手术的阈值低，且与哥伦比亚的开腹手术组相比，并发症发生率没有更高。完全治疗性腹腔镜手术组的手术时间、经口进食时间和住院时间更低。
