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J Minim Access Surg. 2010 Oct-Dec; 6(4): 126.
PMCID: PMC2992665

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

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

1. Umman P. Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury: A case report. J Min Access Surg. 2010;6:16–8. [PMC free article] [PubMed]
2. Poole GV, Thomae KR, Hauser CJ. Laparoscopy in trauma. Surg Clin North Am. 1996;76:547–56. [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.
4. Villavicencio RT, Aucar JA. Analysis of laparoscopy in trauma. J Am Coll Surg. 1999;189:11–20. [PubMed]

Articles from Journal of Minimal Access Surgery are provided here courtesy of Medknow Publications