Trauma Screening Laparoscopy

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In Private Practice, we increasingly are using minimal invastive approaches.    With blunt and penetrating injury to the abdomen, a negative laparoscopy gives us confidence.      It is replacing DPL (of course) and FAST as the preferred screening test in abdominal trauma
 
Mohammed   
 
> Subject: RE: Laparoscopy in trauma> Date: Sat, 22 Nov 2008 18:02:25 -0600> From: nmcswai at tulane.edu> To: trauma-list at trauma.org> > 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> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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