Segurança e eficácia da laparoscopia em pacientes com trauma
abdominal contuso: experiência de 12 anos em um serviço de
referência em trauma

Sérgio Henrique Bastos Damous; Eric Arcanjo Brignel; Carlos Augusto Metidieri Menegozzo; Pedro Henrique Ferreira Alves; Marcelo Cristiano Rocha; Francisco de Salles Collet e Silva; Edivaldo Massazo Utiyama

doi:10.1590/0100-6991e-2026000626

Original Article

Segurança e eficácia da laparoscopia em pacientes com trauma abdominal contuso: experiência de 12 anos em um serviço de referência em trauma

Safety and effectiveness of laparoscopy in patients with blunt abdominal trauma: a 12-year experience in a reference trauma service

Sérgio Henrique Bastos Damous; Eric Arcanjo Brignel; Carlos Augusto Metidieri Menegozzo; Pedro Henrique Ferreira Alves; Marcelo Cristiano Rocha; Francisco de Salles Collet e Silva; Edivaldo Massazo Utiyama

http://dx.doi.org/10.1590/0100-6991e-2026000626 RCBC, vol.53, e2026000626, 2026

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Resumo

Introdução: O benefício da laparoscopia no trauma abdominal contuso (TAC) permanece em debate. Este estudo analisou pacientes com TAC tratados por laparoscopia em um serviço terciário de referência em trauma no Brasil.

Methods: A retrospective clinical study of hemodynamically stable patients with BAT treated by laparoscopy over a 12-year period was conducted. Laparoscopies were classified as diagnostic (DL) or therapeutic (TL).

Resultados: Durante o período de 12 anos, 85 pacientes com TAC foram tratados por via laparoscópica. A idade mediana foi de 30 anos, com predomínio do sexo masculino (80%) e pacientes classificados como ASA I (72%). A colisão veicular foi o mecanismo de trauma mais frequente (46%). As principais indicações para laparoscopia foram a presença de líquido livre sem lesão parenquimatosa na tomografia computadorizada (TC) (59%) e dor abdominal/sinais de irritação peritoneal (11,5%). A taxa de conversão foi de 26%, e esses pacientes foram incluídos no grupo controle (n=22). Entre as laparoscopias concluídas (n=63), 36% (n=31) foram diagnósticas e 38% (n=32) terapêuticas. O sinal do cinto de segurança esteve presente em 12% dos pacientes da série total. Os procedimentos terapêuticos mais frequentes foram suturas da bexiga, cólon e diafragma. Houve correspondência entre os achados tomográficos e intraoperatórios, sem identificação de lesões despercebidas. O tempo cirúrgico foi maior no grupo de conversão (p<0,05).

Conclusão: A laparoscopia pode ser segura e eficaz no manejo de pacientes vítimas de trauma abdominal contuso, desde que previamente selecionados e hemodinamicamente estáveis. O sucesso dessa abordagem depende do tripé: seleção adequada dos pacientes, cirurgiões treinados e disponibilidade integral de materiais e exames complementares.

Palavras-chave

Laparoscopia; Ferimentos e Lesões; Traumatismos Abdominais; Ferimentos Não Penetrantes

Abstract

Background: The benefit of laparoscopy in blunt abdominal trauma (BAT) remains debated. This study analyzed patients with BAT treated by laparoscopy in a tertiary reference trauma service in Brazil.

Methods: A retrospective clinical study of hemodynamically stable patients with BAT treated by laparoscopy over a 12-year period was conducted. Laparoscopies were classified as diagnostic (DL) or therapeutic (TL).

Results: Over a 12-year period, 85 patients with BAT were treated laparoscopically. The median age was 30 years, and most patients were male (80%) and had an ASA of I (72%). Collision was the most frequent mechanism (46%). The main indications for laparoscopy were the presence of free fluid without parenchymal lesions on CT (59%) and abdominal pain/signs of peritoneal irritation (11.5%). The conversion rate was 26%, and these patients were included in the control group (n=22). Among the laparoscopies (n=63), 36% (n=31) were DL, and 38% (n=32) were TL. The seat belt sign was present in 12% of the patients in the total series. The most frequent therapeutic procedure is suturing of the bladder, colon, and diaphragm. There was correspondence between the CT and intraoperative findings, and there were no unnoticed injuries. The surgical time was longer in the CG (p<0.05).

Conclusion: Laparoscopy can be safe and effective for the management of patients who are victims of blunt abdominal trauma, selected preoperatively and hemodynamically stable. Success in this type of approach depends on a tripod: adequate selection of patients, trained surgeons and full-time availability of materials and subsidiary tests.

Keywords

Laparoscopy; Wounds and Injuries; Abdominal Injuries; Wounds, Nonpenetrating

References

1 Damous SHB, Menegozzo CAM, VON-Bahten LC, Utiyama EM. Laparoscopy in Trauma: Can Brazil fit into the global trend? Rev Col Bras Cir. 2023;50:e20233602EDIT01. doi: 10.1590/0100-6991e-20233602EDIT01-en.

2 Khubutiya MSh, Yartsev PA, Guliaev AA, Levitsky VD, Tlibekova MA. Laparoscopy in blunt and penetrating abdominal trauma. Surg Laparosc Endosc Percutan Tech. 2013;23(6):507-12. doi: 10.1097/SLE.0b013e3182937c37.

3 Johnson JJ, Garwe T, Raines AR, Thurman JB, Carter S, Bender JS, et al. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center. Am J Surg. 2013;205(3):317-20. doi: 10.1016/j.amjsurg.2012.10.021.

4 Hajibandeh S, Hajibandeh S, Gumber AO, Wong CS. Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: A systematic review and meta-analysis. Int J Surg. 2016;34:127-136. doi: 10.1016/j.ijsu.2016.08.524.

5 Li Y, Xiang Y, Wu N, Wu L, Yu Z, Zhang M, et al. A Comparison of Laparoscopy and Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-analysis. World J Surg. 2015;39(12):2862-71. doi: 10.1007/s00268-015-3212-4.

6 Lee PC, Lo C, Wu JM, Lin KL, Lin HF, Ko WJ. Laparoscopy decreases the laparotomy rate in hemodynamically stable patients with blunt abdominal trauma. Surg Innov. 2014;21(2):155-65. doi: 10.1177/1553350612474496.

7 Lin HF, Chen YD, Chen SC. Value of diagnostic and therapeutic laparoscopy for patients with blunt abdominal trauma: A 10-year medical center experience. PLoS One. 2018;13(2):e0193379. doi: 10.1371/journal.pone.0193379.

8 Kawahara NT, Alster C, Fujimura I, Poggetti RS, Birolini D. Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma. 2009;67(3):589-95. doi: 10.1097/TA.0b013e3181a60593.

9 Di Saverio S, Birindelli A, Podda M, Segalini E, Piccinini A, Coniglio C, et al. Trauma laparoscopy and the six w's: Why, where, who, when, what, and how? J Trauma Acute Care Surg. 2019;86(2):344-67. doi: 10.1097/TA.0000000000002130.

10 Adam N, Sorensen V, Skinner R. Not all intestinal traumatic injuries are the same: a comparison of surgically treated blunt vs. penetrating injuries. Injury. 2015;46(1):115-8. doi: 10.1016/j.injury.2014.07.010.

11 Lin HF, Wu JM, Tu CC, Chen HA, Shih HC. Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg. 2010;34(7):1653-62. doi: 10.1007/s00268-010-0485-5.

12 Lin HF, Chen YD, Lin KL, Wu MC, Wu CY, Chen SC. Laparoscopy decreases the laparotomy rate for hemodynamically stable patients with blunt hollow viscus and mesenteric injuries. Am J Surg. 2015;210(2):326-33. doi: 10.1016/j.amjsurg.2014.11.009.

13 Lim KH, Chung BS, Kim JY, Kim SS. Laparoscopic surgery in abdominal trauma: a single center review of a 7-year experience. World J Emerg Surg. 2015;10:16. doi: 10.1186/s13017-015-0007-8.

14 Chestovich PJ, Browder TD, Morrissey SL, Fraser DR, Ingalls NK, Fildes JJ. Minimally invasive is maximally effective: Diagnostic and therapeutic laparoscopy for penetrating abdominal injuries. J Trauma Acute Care Surg. 2015;78(6):1076-83. doi: 10.1097/TA.0000000000000655.

15 Wang J, Cheng L, Liu J, Zhang B, Wang W, Zhu W, et al. Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis. Front Surg. 2022;9:817134. doi: 10.3389/fsurg.2022.817134.

16 Zafar SN, Onwugbufor MT, Hughes K, Greene WR, Cornwell EE 3rd, Fullum TM, et al. Laparoscopic surgery for trauma: the realm of therapeutic management. Am J Surg. 2015;209(4):627-32. doi: 10.1016/j.amjsurg.2014.12.011.

17 Matsevych O, Koto M, Balabyeki M, Aldous C. Trauma laparoscopy: when to start and when to convert? Surg Endosc. 2018;32(3):1344-1352. doi: 10.1007/s00464-017-5812-6.

18 Koto MZ, Matsevych OY, Mosai F, Patel S, Aldous C, Balabyeki M. Laparoscopy for blunt abdominal trauma: a challenging endeavor. Scand J Surg. 2019;108(4):273-279. doi: 10.1177/1457496918816927.

19 Sumislawski JJ, Zarzaur BL, Paulus EM, Sharpe JP, Savage SA, Nawaf CB, et al. Diagnostic laparoscopy after anterior abdominal stab wounds: worth another look? J Trauma Acute Care Surg. 2013 Dec;75(6):1013-7; discussion 1017-8. doi: 10.1097/TA.0b013e3182a1fde8.

20 Coleman JJ, Zarzaur BL. Surgical Management of Abdominal Trauma: Hollow Viscus Injury. Surg Clin North Am. 2017;97(5):1107-1117. doi: 10.1016/j.suc.2017.06.004.

21 Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000 Mar;48(3):408-14; discussion 414-5. doi: 10.1097/00005373-200003000-00007.

22 Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma. 2010;69(1):84-7. doi: 10.1097/TA.0b013e3181db37f5.

23 Achatz G, Schwabe K, Brill S, Zischek C, Schmidt R, Friemert B, et al. Diagnostic options for blunt abdominal trauma. Eur J Trauma Emerg Surg. 2022;48(5):3575-3589. doi: 10.1007/s00068-020-01405-1. Erratum in: Eur J Trauma Emerg Surg. 2020.

24 Gonser-Hafertepen LN, Davis JW, Bilello JF, Ballow SL, Sue LP, Cagle KM, et al. Isolated free fluid on abdominal computed tomography in blunt trauma: watch and wait or operate? J Am Coll Surg. 2014;219(4):599-605. doi: 10.1016/j.jamcollsurg.2014.04.020.

25 Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma. 1995;38(3):350-6. doi: 10.1097/00005373-199503000-00007.

26 Morrison JE, Wisner DH, Bodai BI. Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization. J Trauma. 1996;41(3):509-13. doi: 10.1097/00005373-199609000-00021.

27 Menegozzo CAM, Damous SHB, Sabioni GR, Alves PHF, Rasslan R, de Salles Collet E Silva F, Utiyama EM. Could trauma laparoscopy be the standard of care for hemodynamically stable patients? A retrospective analysis of 165 cases. Surg Endosc. 2023 May 22. doi: 10.1007/s00464-023-10121-x.

28 Pau L, Navez J, Cawich SO, Dapri G. Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A. 2021;31(11):1262-1268. doi: 10.1089/lap.2020.0552.

29 Birindelli A, Podda M, Segalini E, Cripps M, Tonini V, Tugnoli G, et al. TraumaLap Study Group. 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. Updates Surg. 2020;72(2):503-512. doi: 10.1007/s13304-020-00739-0.

30 Advanced Trauma Life Support(r) (ATLS(r)) Student Course Manual 10th edition - Chicago: American College of Surgeons, Committee on Trauma, 2018. 391 p. ISBN 0996826238, 9780996826235.

31 Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico 6, volume 54, 27 de abril de 2023. ISSN 9352-7864.

32 Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg. 2017;43(6):823-833. doi: 10.1007/s00068-016-0744-8.

33 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. doi: 10.1016/s0140-6736(74)91639-0.

34 Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623-9. doi: 10.1097/00005373-198905000-00017.

35 Baker SP, O'Neill B. The injury severity score: an update. J Trauma. 1976;16(11):882-5. doi: 10.1097/00005373-197611000-00006.

36 Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma. 1988;28(1):69-77. doi: 10.1097/00005373-198801000-00010.

37 Damous SHB, Menegozzo CAM, Rocha MC, Collet e Silva F, Utiyama EM. Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil. Rev Col Bras Cir. 2023; 50:e20233527. DOI: 10.1590/0100-6991e-20233527.

38 Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-379. doi: 10.1111/anae.14569.

39 Naumann DN, Vincent LE, Pearson N, Beaven A, Smith IM, Smith K, et al. An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint. J Trauma Acute Care Surg. 2017;83(2):241-8. doi: 10.1097/TA.0000000000001517.

40 Kindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL, et al. Laparoscopy in trauma: An overview of complications and related topics. Int J Crit Illn Inj Sci. 2015;5(3):196-205. doi: 10.4103/2229-5151.165004.

41 Cinquantini F, Tugnoli G, Piccinini A, Coniglio C, Mannone S, Biscardi A, et al. Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries After Blunt Trauma: Correlation With Trauma Surgery Findings in 163 Patients. Can Assoc Radiol J. 2017;68(3):276-85. doi: 10.1016/j.carj.2016.07.003.

42 Leow P, Kong V, Rajaretnam N, Ah Yen D, Amey J, Denize B, et al. Contemporary management of isolated free fluid on computed tomography scan in blunt abdominal trauma-experience from a Level 1 trauma centre in New Zealand. N Z Med J. 2022;135(1557):28-37.

43 Mahmood I, Tawfek Z, Abdelrahman Y, Siddiuqqi T, Abdelrahman H, El-Menyar A, et al. Significance of computed tomography finding of intra-abdominal free fluid without solid organ injury after blunt abdominal trauma: time for laparotomy on demand. World J Surg. 2014;38(6):1411-5. doi: 10.1007/s00268-013-2427-5.

44 Chiu HH, Tee YS, Hsu CP, Hsu TA, Cheng CT, Liao CH, et al. The Role of Diagnostic Laparoscopy in the Evaluation of Abdominal Trauma Patients: A Trauma Quality Improvement Program Study. World J Surg. 2023;47(10):2357-66. doi: 10.1007/s00268-023-07113-2.

45 Kaur S, Bagaria D, Kumar A, Priyadarshini P, Choudhary N, Sagar S, et al. Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomized controlled trial. Eur J Trauma Emerg Surg. 2023;49(1):1-10. doi: 10.1007/s00068-022-02089-5.

46 Huang GS, Chance EA, Hileman BM, Emerick ES, Gianetti EA. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma. JSLS. 2017;21(2):e2017.00013. doi: 10.4293/JSLS.2017.00013

Submitted date:
01/23/2026

Accepted date:
04/23/2026