1. ‘A STUDY ON ROLE OF
LAPAROSCOPY IN
ABDOMINAL TRAUMA’
PRESENTED BY
DR.DEVENDRAN
GENERAL SURGERY. DNB

2. A STUDY ON ROLE OF
LAPAROSCOPY IN ABDOMINAL
TRAUMA
• INTRODUCTION.
• Road traffic accidents are the most common cause of
abdominal injuries.
• he environment that human being has created exposes
him to variety In tof injuries.
• Other mode of injuries are falls,crimes and
assults,wars,social conflicts automobiles pedestrian
accidents etc.
• For Abdominal trauma patients requires a art of
resuscitation,early diagnosis,intial evaluation and manage
ment and lastly perfect surgical skills…
• In abdominal trauma most commonly injured organ
SPLEEN [45 to 55] folled by liver[35to45], kidney

3. • Due to research and advances in diagnostic field like
USG,DPL,CT scan abdomen,laparoscopy chances of
negative laparotomies significantly reduced..
• With advent and development of new technology
laparoscopy minimal access surgery has diagnostic
and definitive therapeutic role in abdominal trauma.
• In the past laparoscopy only limited to dignostic
purpose, but now a days there is availability of
sohisticated equipments ,instruments.laparoscopy is
being used more and more for diagnostic as well as
therapeutic measure…

4. BRIEF HISTORY OF LAPAROSCOPY
• Laparoscopy surgery developed over many
decades. Difficult to pinpoint one individual
pioneer to approach..
• In 1902. sirGeorg Kelling.. From Dresden
.Jermany Performed laparoscopy in dogs.
• In 1910 sir Hons christian Jacobeus. From
Swedon performed laparoscopy in humans.
Abdomen and thoracic injuries..
• Next few decades popularised by number of
persons..

5. • First laparoscopy cholecystectomy performed by sir Erich
Muhe..
• First appendicectomy performed by sir Kurt semp. In 1981.
• In 1956 sir Lamy used laparoscopy for splenic trauma patients.
• Laparoscopic splenectomy performed by Sutherland…

6. REVIEW OF LITERATURE
• A Journal of the society of laparoscopic
surgeons[JSLS]2011’ publication from north
carolia USA.
• A retrospectrive review of all trauma patients
undergone diagnostic and therapeutic
laparoscopy was pereformed from 2001
to2010.
• Laparoscopy performed in 16 patients.
Average age 35 yrs. Most of the injuries due to
mtor vehicle accidents ,falla,stabs..

7. • Dignostic lap performed in 11[69%]. Among this 3
only requiring to conversion to open procedure..
• Successful therapeutic lap was performed for 5
for repair of isolated injuries. To diaphragm,small
bowel, colon injuries.
• CONCLUSION..
• With this study they concluded diagnostic lap is
better and avoids un necessary laparotomies

8. • JOURNALS OF THE SOCIETY OF
LAPAROSCOPIC SURGEONS. JSLS.1998..
• A prospective case series conducted in new
york..1995 to1997. bellevue hospital trauma
and shock unit..
• 70 consecutive patients were evaluated over 2
yr period. . Avarage length of the stay for
laparoscopy only 1.5 days.. For negative
celiotomy 5.2 dfays

9. age group 16 to 64. males 64[91%] females9[9%] among
this 44[63%] ant abdominal wall injury. 16 stab injury
13 gun shots injury..
Evaluated laparoscopy after indeterminate CT scan’’
CONCLUSION…
Oparative time is reduced [16 to60min]’
Length of stay in hospitals reduced.. 1.5 days
Morbity decreased..
Anaesthesia related complications min… no tension
pneumothorax…

10. • No intra abdominal injuries missed in
laparoscopy.. 2 out of ten left lower chest
require urgent surgery for missed ongoing
hemothorax.
• With this study and experience they
concluded laparoscopy is the safe and
accurate tool for identifying abdominal
injuries .decreases negative laparotomies

11. THE INTERNET JOURNAL OF SURGERY .2013.
VOL.30. NOVEMBER 4.
Conducted aclinical study in laparoscopy in
diagnostic and management of acute
abdomen in south indian population.
50 cases of acute abdomen was done to study
the role of laparoscopy in dignostic and
therapeutic purpose in acute abdomen.

12. • Out of 50 cases studied 27[54%] were male.
23[46%] were female patients. Average age
30.5 yrs..
• Abdominal pain was the universal complaint
present in all 50 patients.[100%]
• Vomiting was present in 42[84%] patients.
• Fever in 31[62%]
• Abdominal distension in 12[24%].
• Alteration in bowel habbits noted in 9[18%]
• Burning micturition in 5[10%]

13. • In this study 9[18%] patients had previous
surgery.
• Laparoscopy was diagnostic in 50[100%]
cases. Could accomplish treatment in47 [94%]
patients..
• Unnecessary laparotomy were avoided in 7
patients.
• Only 3 converted into laparotomy.

14. • CONCLUSION.
• This study establishes the fact that
laparoscopy is a very accurate tool in diagnosis
and treatment of acute abdomen.
• Non therapeutic laparotomies avoided less
hospital stay.

15. • WORLD JOURNAL OF EMERGENCY SURGERY
2006 also conducted stydy on diagnostic and
therapeutic purpose of laparoscopy..
• They concluded laparoscopy is an excellent
modality in acute abdomen and diaphragm
injuries.

16. AIMS AND OBJECTIVES
• TO KNOW THE MODE OF INJURY AND
incidence of organ involvement in abdominal
trauma patients.
• To study the management of trauma abdomen
in different mode of injuries
• To find out the diagnostic and therapeutic role
of laparoscopy in abdominal trauma patients.
• To reduce the incidence of negative
laparotomies.

17. • To find out the limitations and contra indications
of laparoscopy in abdominal trauma patients.
• To review the method of patient selection
,operative technique, operative time ,intra
operative and post operative complications.
• To find out the impact of laparoscopy on patients
with trauma abdomen in terems of early
rehabilitation ,cost effective ness , decreased
hospital stay and cosmosis

18. INDICATIONS FOR LAPAROSCOPY
• Those cases CT is inconclussive diagnostic
laparoscopy is indicated.
• Those cases requiring surgical intervention
minimal acces laparoscopy can be performed.
• Hemodynamically stable patients.
• Diagnostic peritoneal lavage[DPL] positive
cases.
• USG/FAST positive..

19. • Some abdominal injury positive with intial
diagnostic procedures.
• Some prospectrive sudies conducted median
sge groupe 23 for most of lap patients. Range
between 11 to 20 yrs and 21 to 30 yrs

20. POTENTIAL ADVANTAGES OF
LAPAROSCOPY
• Main advantages of laparoscopy are
• Small incision
• Quick recovery
• Less pain
• Short post operative hospital stay
• Cosmatically good compared with laparotomy.
• Easy mobilisation.
• Min post operative complications

21. LIMITATIONS OF LAPAROSCOPY
• Inability to visualise entire abdominal cavity.
• Especially retroperitoneum and posterior
diaphragm.
• Hemopritoneum may not be clearly visible by
lap due to unclear field.
• Some times hollow viscus perforations missed
with laparoscopy lead to prolanged leak and
complications

22. Contraindications for laparoscopy
• Trauma with EDH/SDH.
• Abdominal associate with some compound spine
fractures, severe chest injuries…
• Hemodynamically instability.
• In difficult intubation.
• Pregnacy.
• Uncontrolled coagulopathy.
• Patients with multiple previous laparotomies.
• Massive intestinal dilatation with abdominal
distension.

23. • METHOD.
• patients were given general anaesthesia in
supine position.
• first trocar insertwed at supra umbilical ridge
with open hassans method with
pneumopritoneum with pressure 12 to15 mm of
hg.
• Pneumoperitoneum created with co2. it is un
inflammed and least irritant gas. So it is comonly
used.

24. • Other port site created under direct vision.
• The standard three main ports are umbilical
port , rt sided port and left sided port..
• Extra port is made according to organ injury

25. Some complications of laparoscopy
• Laparoscopy is a commonly pereformed preocrdure
• Complications are very minimal
• Complications are minor and major complications..
• Minor are
• Feeling sick ,fever, vomiting
• Minor bleeding and bruicing around the incision
• Post op infection.
• V.rarly port site hernias..
• Urinary retention

26. • MAJOR are
• damage to organ such as bowel or bladder.
• which could result in the loss of organ
function.
• Damage to major artry
• Complications can occur with CO2 such as
bubles entering in to veins and arteries
throbosis

27. • Some times pul embolism can occur
• In lap cholecystectomy some bile duct injuries
are common.
• Miss identification of cystic duct with common
bile duct and common hepatic duct..
• Delayed stricture due to thermal injury