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LETTER TO EDITOR
Year : 2010  |  Volume : 6  |  Issue : 4  |  Page : 126
 

Missed injury and complication after laparoscopy in trauma: Is the procedure still preferable?


Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand

Date of Web Publication23-Nov-2010

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok 10160
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.72603

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How to cite this article:
Wiwanitkit V. Missed injury and complication after laparoscopy in trauma: Is the procedure still preferable?. J Min Access Surg 2010;6:126

How to cite this URL:
Wiwanitkit V. Missed injury and complication after laparoscopy in trauma: Is the procedure still preferable?. J Min Access Surg [serial online] 2010 [cited 2020 Jan 23];6:126. Available from: http://www.journalofmas.com/text.asp?2010/6/4/126/72603


Dear Sir,

Use of laparoscopy in trauma is still a controversial issue. The high rate of missed injury and possibility of induction of severe complications should be carefully considered. In the recent publication by Umman, the unfavourable outcome can also be seen. [1] The suggestion that "the best applications may be in haemodynamically stable patients with stab wounds or tangential wounds to the anterior abdominal wall" [1],[2] should be revised. Although the complication due to the procedure might not be highly prevalent and might relate to the specific difficulty in specific case and experience of the practitioner, the very high rate of missed injury might be a very big problem. Based on the data that "approximately 5% of patients with blunt trauma and 10% to 15% of patients with penetrating injuries to the chest and abdomen have diaphragmatic injuries" [1],[3] and "as a diagnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient," [1],[4] it can be estimated that missed diaphragmatic injuries can be seen in 2.1% to 3.9% of patients with blunt trauma and 4.1% to 11.6% of patients with penetrating injuries to the chest and abdomen if diagnostic laparoscopy is used. For sure, the high rate of missed injury means repeated abdominal exploration later on, and medical litigation might be another issue that should be kept in mind. Hence laparoscopy as minimal access surgery should have limited role and usefulness in trauma.

 
  References Top

1.Umman P. Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury: A case report. J Min Access Surg 2010;6:16-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Poole GV, Thomae KR, Hauser CJ. Laparoscopy in trauma. Surg Clin North Am 1996;76:547-56.  Back to cited text no. 2
[PUBMED]    
3.Stein SL, Schulz JT. Abdominal trauma 2. Diaphragm and Abdominal wall. In: Sheridan RL, editor. The Trauma Handbook of the Massachusetts General Hospital. London, United Kingdom: Lippincott Williams and Wilkins; 2004. p. 402.   Back to cited text no. 3
    
4.Villavicencio RT, Aucar JA. Analysis of laparoscopy in trauma. J Am Coll Surg 1999;189:11-20.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  




 

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2004 Journal of Minimal Access Surgery
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