The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research. 

/pdf/wses-guidelines-on-blunt-and-penetrating-bowel-injury-3gcjit1h.pdf

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Technique, indications and outcomes of laparoscopic splenectomy in stable trauma patients have not been well described yet. All hemodynamically non-compromised abdominal trauma patients who underwent splenectomy from 1/2013 to 12/2017 at our Level 1 trauma center were included. Demographic and clinical data were collected and analysed with per-protocol and an intention-to-treat comparison between open vs laparoscopic groups. 49 splenectomies were performed (16 laparoscopic, 33 open). Among the laparoscopic group, 81% were successfully completed laparoscopically. Laparoscopy was associated with a higher incidence of concomitant surgical procedures (p 0.016), longer operative times, but a significantly faster return of bowel function and oral diet without reoperations. No significant differences were demonstrated in morbidity, mortality, length of stay, or long-term complications, although laparoscopic had lower surgical site infection (0 vs 21%).The isolated splenic injury sub-analysis included 25 splenectomies,76% (19) open and 24% (6) laparoscopic and confirmed reduction in post-operative morbidity (40 vs 57%), blood transfusion (0 vs 48%), ICU admission (20 vs 57%) and overall LOS (7 vs 9 days) in the laparoscopic group. Laparoscopic splenectomy is a safe and effective technique for hemodynamically stable patients with splenic trauma and may represent an advantageous alternative to open splenectomy in terms of post-operative recovery and morbidity.

/pdf/laparoscopic-splenectomy-as-a-definitive-management-option-28dgtxfh46.pdf

Laparoscopic splenectomy as a definitive management option for high-grade traumatic splenic injury when non operative management is not feasible or failed: a 5-year experience from a level one trauma center with minimally invasive surgery expertise.

Introduction: Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute to these data by reporting our experience with laparoscopic management of blunt and penetrating trauma in a Belgian center. Materials and Methods: We retrospectively collected data on all trauma patients admitted to the Saint-Pierre University Hospital in Brussels, Belgium, over the 4-year period from January 2014 to December 2017. Hospital records for patients subjected to exploratory laparoscopy were retrospectively reviewed, and a descriptive analysis was reported. Results: There were 26 patients at a mean age of 40 years treated with laparoscopic exploration for injuries from blunt trauma (7), stab wounds (14), and gunshot injuries (5). The median interval between the arrival at the emergency unit and diagnostic laparoscopy was 175 minutes (range: 27-1440), and the median duration of operation was 119 minutes (range: 8-300). In all patients who underwent laparoscopy for trauma, there were 27% overall morbidity, no mortality, 11% reoperation rate, 7.4% conversions, and 19% incidence of negative laparoscopy. The median intensive care unit stay was 3 days (range: 0-41), and median total hospital stay was 7 days (range: 2-78). Conclusions: Laparoscopy is a safe, feasible, and effective tool in the surgical armamentarium to treat hemodynamically stable patients with blunt and penetrating abdominal trauma. It allows complete and thorough evaluation of intra-abdominal viscera, reduces the incidence of nontherapeutic operations, and allows therapeutic intervention to repair a variety of injuries. However, it requires appropriate surgeon training and experience with advanced laparoscopic techniques to ensure good outcomes.

Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature.

The expansion of the elderly population led to an increased number of older adults presenting to emergency departments following trauma; the outcome of injuries in geriatric patients is worsened by a weaker mechanism of compensation, ongoing chronic medical conditions, and increased risk for complications due to a greater number of comorbidities and physiological changes.

Abdominal Trauma in the Elderly

Advantages of the laparoscopic approach in various abdominal emergencies have led to increasing consensus on the need for more widespread adoption of minimally invasive techniques, with multiple studies reporting on their safety, feasibility, and improved outcomes compared to standard open surgery. A laparoscopic approach is now widely recommended in acute appendicitis, acute cholecystitis, and perforated peptic ulcers. It is gaining a larger role in other conditions, although some are still debated, including laparoscopic lavage for perforated diverticulitis, laparoscopic lysis for adhesive small bowel obstruction, and laparoscopic reduction and repair for obstructed hernias, amongst others. In patients in whom the diagnosis of continuing acute abdominal pain of less than 1-week duration remains elusive, diagnostic laparoscopy represents a valid option to consider, with a diagnostic accuracy ranging from 89 to 100%. In hemodynamically non-compromised patients, laparoscopy is a reliable tool for diagnosing patients with penetrating and blunt abdominal injury and, in selected patients, it may have a therapeutic role in the treatment of several types of injuries. Absolute contraindications to laparoscopy in acute care surgery include surgeons with little laparoscopic experience, hemorrhagic or septic shock with hemodynamic instability, and few other conditions.

Laparoscopy and Minimally Invasive Surgery Techniques in Acute Care Surgery

The aim of this study was to evaluate the trend in use, feasibility and safety of laparoscopy in a single level 1 European trauma centre. Laparoscopy in abdominal trauma is gaining acceptance as a diagnostic and a therapeutic tool as it reduces surgical invasiveness and may reduce post-operative morbidity. All trauma patients who underwent a laparoscopic procedure between January 2013 and December 2017 were retrospectively analysed. A sub-analysis of isolated abdominal trauma was also performed. There has been a significant increase in the use of this technique in the considered time period. A total of 40 patients were included in the study: 17 diagnostic laparoscopies and overall 32 therapeutic laparoscopies. Conversion rate was 15%. All patients were hemodynamically stable. The majority of patients were younger than 60 years, with an ASA score of I–II and sustained a blunt trauma. Mean ISS score was 17. Colon and diaphragm were the most commonly laparoscopically diagnosed injuries, while splenectomy was the most common operation. The average operating time was 106 min. There were no missed injuries, no SSI, no re-interventions and no mortality related to the surgical procedure. The average length of stay was 14 days. No significant difference was found in the isolated abdominal trauma group. Laparoscopy is an emergent safe and effective technique for both diagnostic and therapeutic purposes in selected stable abdominal penetrating or blunt trauma patients. However, these results need to be put in relation with the level of the centre and the expertise of the surgeon.

Is the minimally invasive trauma surgeon the next (r)evolution of trauma surgery? Indications and outcomes of diagnostic and therapeutic trauma laparoscopy in a level 1 trauma centre

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Is the minimally invasive trauma surgeon the next (r)evolution of trauma surgery? Indications and outcomes of diagnostic and therapeutic trauma laparoscopy in a level 1 trauma centre