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Laparoscopic-Assisted Approach for Penetrating Abdominal Trauma: An Underutilized Technique.

INTRODUCTION
Diagnostic laparoscopy is well accepted in the management of penetrating abdominal trauma (PAT). Therapeutic laparoscopy, on the other hand, remains controversial. In patients with multiple hollow viscera injuries, laparoscopy is usually converted to laparotomy. We aim at describing the laparoscopic-assisted technique in the management of patients with PAT. Using our experience with laparoscopy, we tailored the technique to the setting of PAT.


METHODS
The laparoscopic-assisted approach (LAA) was adapted to a trauma setting and prospectively evaluated. The technical details and indications for the technique were investigated. The distinctive steps of the technique were identified and described descriptively. The decision-making process was described as a separate step in the technique.


TECHNIQUE
After having established pneumoperitoneum and ports placement, the source of bleeding is identified and controlled. Systematic inspection of intraperitoneal and retroperitoneal organs is done. In the case of multiple injuries, the hollow viscera are exteriorized via the 4-8 cm incision and extracorporeal inspection, repair, resection, and anastomosis are performed. The other part of the procedure is completed intracorporeally. Over a 2-year period, 23 patients were managed with LAA, 13 patients with stab wounds, and 10 patients with gunshot wounds. Commonly performed procedures were hollow viscera repairs, resections, and anastomoses. There were neither missed injuries nor conversion among patients managed with LAA.


CONCLUSION
The LAA is underutilized for PAT. This technique can be successfully used as a diagnostic and therapeutic tool in the management of stable patients. It offers the advantages of minimally invasive surgery and the speed and versatility of an open procedure.