Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2018; 24(2): 104-109 | DOI: 10.5505/tjtes.2017.83404  

Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice

Georgios Theodoros Liagkos1, Charalampos Spyropoulos2, Gerasimos Tsourouflis3, Aris Papadopoulos1, Paulos Ioannides1, Constantine Vagianos3
11st Department of Surgery, Nikaia General Hospital, Nikaia, Piraeus, Greece
23rd Department of Surgery, Iaso General Hospital, Holargos, Athens, Greece
32nd Propedeutic Department of Surgery, Laikon Hospital, National & Kapodestrian University of Athens, Greece

BACKGROUND: The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital.
METHODS: We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated.
RESULTS: One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM.
CONCLUSION: Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.

Keywords: Blunt abdominal trauma, hemodynamic stability; non-operative management.


Yüksek derecede selektif olgularda künt abdominal travmanın başarılı cerrahidışı tedavisi: Güvenli ve etkili bir seçim

Georgios Theodoros Liagkos1, Charalampos Spyropoulos2, Gerasimos Tsourouflis3, Aris Papadopoulos1, Paulos Ioannides1, Constantine Vagianos3
11st Department of Surgery, Nikaia General Hospital, Nikaia, Piraeus, Greece
23rd Department of Surgery, Iaso General Hospital, Holargos, Athens, Greece
32nd Propedeutic Department of Surgery, Laikon Hospital, National & Kapodestrian University of Athens, Greece

AMAÇ: Abdominal yaralanmaların cerrahi dışı tedavisi (CDT) son 10 yıllarda geniş kabul görmüştür. Bu çalışmada, bölgesel Yunanistan hastanesinde künt abdominal travmada (KAT) CDT etkinliği değerlendirildi.
GEREÇ VE YÖNTEM: Künt abdominal travma için 2008–2015 arası hastaneye yatırılmış hastaların tümüne önceden kararlaştırılarak uygulanmış tedavi protokollerinin sonuçları incelendi. Protokol peritonit belirtileri olmayan hemodinamik açıdan stabil hastalarda CDT’yi önerdi. Demografik özellikler, yaralanmanın tipi, yaralanmış organ(lar), tedavi tipi (cerrahi’ye karşın cerrahi dışı) Yaralanma Şiddeti Skoru (YŞS), morbidite, mortalite oranları ve sağlık bakım maliyetleri değerlendirildi.
BULGULAR: Künt abdominal travma nedeniyle bölümümüze yatırılmış146 hasta çalışmaya alındı. Bunlar arasında 49’u ameliyat edilmiş, 97’sine CDT uygulanmıştı. Yaralanma Şiddeti Skoru cerrahi grubunda istatistiksel açıdan daha yüksek olmasına rağmen iki grup arasında karaciğer, dalak ve böbreklerdeki yaralanmanın şiddet derecesi açısından farklılık yoktu. Cerrahi dışı tedavi uygulanan hiçbir olgu için muhtemelen CDT’nin katı dahil edilme kriterleri nedeniyle cerrahi tedaviye geçiş gerekmemişti.
TARTIŞMA: Hemodinamik açıdan stabil, fizik muayenesi normal yüksek derecede selektif olgular yaralanmanın derecesine bakılmaksızın cerrahi dışı yöntemlerle tedavi edilebilir. Yaralanma Şiddeti Skoru cerrahi tedavi riskine ilişkin bağımsız bir risk faktörüdür.

Anahtar Kelimeler: Cerrahi dışı tedavi, hemodinamik stabilite; künt karın travması.


Georgios Theodoros Liagkos, Charalampos Spyropoulos, Gerasimos Tsourouflis, Aris Papadopoulos, Paulos Ioannides, Constantine Vagianos. Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice. Ulus Travma Acil Cerrahi Derg. 2018; 24(2): 104-109

Corresponding Author: Georgios Theodoros Liagkos, Greece


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