Matsevych O, et al. – The goal for performing this work was to assess indications for trauma laparoscopy and for conversion to laparotomy. Findings suggested laparoscopic management of all stable trauma patients as safe. The use of sound laparoscopic equipment by a well–coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Conversion should be sought in case of continuous intraoperative bleeding, the complexity of injuries, deterioration of the patient, poor visibility, and equipment failure.

Methods

• The authors retrospectively analyzed all trauma patients managed with laparoscopy over a 4-year period.
• They investigated indications for laparoscopy, morbidity, and reasons for conversion and sought predictors of morbidity and conversion.
• Review and update of the management algorithm of trauma patients were performed.

Results

• In 318 stable trauma patients, laparoscopy was utilized.
• In this study, 35 patients presented with blunt and 283 with penetrating abdominal injuries.
• Authors observed the conversion rate of 11.7% for penetrating and 22.9% for blunt abdominal trauma patients.
• Continuous intraabdominal bleeding that could not be controlled quickly was identified as the most common reasons for conversion.
• Other reasons for conversion included multiple complex injuries, hemodynamic instability, and intraoperative visualization problems.
• Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases.
• Findings revealed no missed injuries.
• There appeared complications in 21.2% in the converted group and in 9.6% in the laparoscopic group.
• Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH seemed associated with conversion.