Laparoscopy in trauma

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Tim

Yes it *can* be an indication but *should* it? A hole in the diaphragm
is just like a hole in the peritoneum from any other direction. This is
violation of the peritoneum, it is not sign of repairable injury. I have
not read those studies for a while, but using identification of
"repairable injury" as a positive outcome and no "repairable injury" as
a negative outcome, I do not believe that they showed any different
outcome than did Nance or Shafton. This would make the general
anesthesia and the insertion of the laparoscopy an unnecessary
operation.

And Yes, I know that many of today's surgeons (or at least this is true
of the younger surgeons in the US), can (will) no longer do effective
abdominal examinations, and they VOMIT, but that does not make the
principle incorrect

Use the indications that Nance described. 1) significant blood loss =
uncontrolled hemorrhage, 2) acute abdomen = hole in the GI tract go to
the OR  for a laparotomy. Otherwise after 24 hours of observation with
*serial physical examinations*, if neither #1 or #2 have developed then
discharge home without any operation

Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy
Hardcastle
Sent: Saturday, November 22, 2008 12:12 PM
To: Trauma & Critical Care mailing list
Subject: RE: Laparoscopy in trauma


> There is very little if any use for the laparoscopy in the primary
> assessment and management of either blunt or penetrating trauma of the
> abdomen.
>VATS is different. It can be used for the management of hemorrhage in
> most chest injuries. It can be used to identify diaphragmatic
> perforation ( and the potential need for a laparotomy). And it is
> cheaper in complications, time and money than a thoracotomy
>
> The chest and abdomen are two different cavities, two different types
of
> problems tow different kinds of complications and two different
> outcomes. Do not try to compare these in the same thought process
>
> Norman
>
> Norman McSwain Jr, MD FACS
> Trauma Director Charity Hospital
> Professor of Surgery
> Tulane University School of Medicine
> 504 988 5111
Norm

Maybe one place for lap-scope is where VATS not available and there is
lower left chest stab (not GSW) looking for occult diaphragm injury. At
least three large series supporting this.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service

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