[Laparoscopy for abdominal trauma].
With increasing experience in minimally invasive surgery, laparoscopy's role in abdominal trauma can be defined exactly. Main exclusion criteria are hemodynamic instability and increased intracranial pressure. A literature review of 1996 to 2006 reveals perforating injury mainly of the left thoracoadominal area as the most important indication for laparoscopy . Its goal is to determine intraperitoneal lesions and integrity of the abdominal wall and diaphragm. Minor injuries of the parenchymatous organs and diaphragm can be successfully repaired laparoscopically. In blunt abdominal trauma, laparoscopy is used as a complementary diagnostic device in case ultrasound and multislice CT show unclear findings and the patient's clinical status requires invasive measures. The clear weakness of laparoscopy in abdominal trauma is its inability to identify reliably hollow viscus perforation and retroperitoneal injury. In this, sensitivity is only 25%. In case of proven lesions of the gastrointestinal tract, conversion to laparotomy is to be considered. Despite the reports on laparoscopic treatment, open repair of hollow organ injuries is still to be recommended.
Becker
H P
HP
Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Rübenacher Strasse 170, 56072 Koblenz, Deutschland. Horstpeter.becker@t-online.de
Willms
A
A
Schwab
R
R
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D000465:Algorithms; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D006801:Humans; D007422:Intestines / Q000293:injuries / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery