Sol torakoabdominal býçak yaralarýnýn tedavisinde tanýsal laparoskopi gerekli midir?

AMAÇ: Diyafram rüptürünün tanýsý ve cerrahi tedavi gerektiren hastalarýn ayýrt edilebilmesi, mevcut teþhis algoritmalarýna ve ileri görüntüleme tek-niklerinin varlýðýna ragmen halen güçtür. Zamanýnda tedavi edilmediðinde, kesici/delici alet yaralanmalarýna baðlý akut travmatik diyafragma hasarý, organ herniasyonu mevcudiyetinde artan bir eðilimle birlikte, yüksek bir mortalite ve morbidite oranýna sahiptir. Bu çalýþmada, anterior torakoabdo-minal býçak yarasý olan hastalarda tanýsal laparoskopinin etkinliðini araþtýrmayý ve olgularýn takip sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Ekim 2012-2022 arasýnda kesici/delici alet yaralanmasý ile baþvuran hastalarýn yer aldýðý kurumsal veri tabanýmýzý retrospektif olarak inceledik. Tanýsal laparoskopi uygulanan hastalar diyafragma yaralanmasý varlýðýna göre iki gruba ayrýldý. Demografik veriler, bilgisayarlý tomog-rafi (BT) görüntülemenin tanýdaki baþarýsý, hemomediastinum, pnömomediasten varlýðý, tüp torakostomi uygulamasý, eþlik eden organ yaralanmasý, cerrahi tipi, cerrahi süresi, komplikasyonlarý ve hastanede kalýþ süreleri, gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Penetran sol torakoabdominal yaralanmasý olan 39 hastaya tanýsal laparoskopi yapýldý, BT'nin tanýsal duyarlýlýðý %63.16 (%95 GA %38.36 ila %83.71) ve özgüllüðü %100 (%95 GA %82.35 ila %100.00) idi. Analiz edilen deðiþkenler açýsýndan gruplar arasýnda istatistiksel olarak anlamlý bir fark bulunamazken, ameliyat süresi diyafragma hasarý bulunan grupta anlamlý olarak daha uzun saptandý (p<0.01). On dört hastada eþlik eden visseral organ yaralanmalarý mevcuttu.
SONUÇ: Tanýsal laparoskopi, acil serviste, özellikle tecrübeli bir radyoloðun 24 saat bulunamamasý durumunda ve hastanýn ayný ekip tarafýndan yakýn takibinin saðlanamadýðý durumlarda altýn standart bir taný yöntemi olma özelliðini halen korumaktadýr.

Is diagnostic laparoscopy necessary in the management of left thoracoabdominal stab wounds?

BACKGROUND: The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases.
METHODS: We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups.
RESULTS: Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36–83.71%), and a specificity of 100% (95% CI 82.35–100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries.
CONCLUSION: Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.