Massachusetts Chapter of the American College of Surgeons

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Use of Minimally Invasive Surgery for the Management of Hollow Viscus Traumatic Injuries.
Andrew Litwin, MD, Aixa Perez, John Romanelli, MD, Michael Tirabassi, MD
Baystate Medical Center, Springfield, MA

The objective of this study is to assess surgical outcomes following the initial use of laparoscopy versus laparotomy when managing patients with hollow viscus injuries (HVI) due to trauma.

Using the TQIP database, we identified patients from 2015-2017 with ICD-10 Diagnosis codes for hollow viscus trauma. We separated surgical patients into groups based on surgical intervention, MOI, and type of procedure. Patient outcomes were stratified by major (ISS>15) and minor trauma. Continuous variables were compared by ANOVA and categorical variables compared by Chi-Square. Analysis performed using STATA 16.

Of 16,284 patients that matched inclusion criteria, 1986 patients received a surgical intervention, 1911(96%) were open and 75(4%) were laparoscopic. For minor trauma, mean length of stay(days) after open surgery was 5 while for laparoscopy it was 2(P=0.04). There were 203 complications noted in the open group and 7 in the laparoscopic group(P=0.19). For major trauma, mean length of stay(days) after open surgery was 5 while for laparoscopy it was 6(P=0.54). There were 242 complications in the open group and 1 in the laparoscopic group(P=0.07).

For those that required surgery for HVI, we found laparoscopy to be safe, with decreased hospital stay in patients with minor trauma and decreased complications in major trauma. Additionally there was a noted trend toward increased likelihood of discharge to home for major and minor trauma. Importantly, this option appears to be underutilized despite these potential benefits, particularly when only a diagnostic procedure was required.

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