title: Role of Laparoscopy in Patients With Abdominal Trauma at Level-I Trauma Center.
abstract: BACKGROUND
  Abdominal trauma is one of the preventable causes of death in polytrauma patients. Decision and timing of laparotomy is a major challenge. Rate of nontherapeutic laparotomy is still high. Laparoscopy can avoid nontherapeutic laparotomy and also provide a reliable and accurate diagnosis of injury.
  
  
  METHODS
  This ambispective observational study was conducted in the division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute Medical Sciences, New Delhi. Retrospective analysis of prospectively maintained data of cases from January 1, 2008 through April 30, 2013 and prospective analysis of cases from May 1, 2013 through March 31, 2015 was done using appropriate measures. Hemodynamically stable or responders fulfilling inclusion criteria were included. Selected patients underwent the laparoscopic procedure and if required converted to laparotomy.
  
  
  RESULTS
  Of the 3610 patients of abdominal trauma, laparotomy was done in 1666 (46.14%) patients and laparoscopy was done in 119 (3.29%) patients. Rate of reduction of nontherapeutic laparotomy in patients with abdominal trauma using diagnostic laparoscopy was 55.4%. However laparotomy could be avoided in 59.7%. Laparoscopy was 100% accurate in identifying injuries in our study. No injuries were missed in these patients. Fever and wound infection were significantly higher in laparotomy group. Chest infection and sepsis were also higher in laparotomy group but the difference was not statistically significant. Median length of hospital stay in laparoscopy group was 4 days (range: 1 to 28 d) and in laparotomy group was 9.5 days (range: 2 to 55 d) with P-value of 0.001.
  
  
  CONCLUSIONS
  Laparoscopy has a role in management of hemodynamically stable patients with suspected abdominal injury to prevent nontherapeutic laparotomies, and thereby decreasing postoperative complications.
authors.affiliation: JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Purushottam
authors.initials: P
authors.lastname: Parajuli
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Virinder Kumar
authors.initials: VK
authors.lastname: Bansal
authors.forename: Sushma
authors.initials: S
authors.lastname: Sagar
authors.forename: Biplab
authors.initials: B
authors.lastname: Mishra
authors.forename: Maneesh
authors.initials: M
authors.lastname: Singhal
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamangatti
authors.forename: Babita
authors.initials: B
authors.lastname: Gupta
authors.forename: Chhavi
authors.initials: C
authors.lastname: Sawhney
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007194:India; D015601:Injury Severity Score; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*