Plotnikov A. Efficiency of laparoscopic operations with closed concomitant abdominal trauma

Thesis work analyzes the results of diagnosing and treatment of 822 patients with polytrauma with the prevailing abdominal and thorax injuries. In 428 cases laparoscopy has been used for the purposes of diagnosing and treatment. In 150 (35 %) cases, no significant injuries have been discovered, and the surgery ended with the abdominal drainage. In 162 (37.9 %) cases, laparoscopic surgery and in 116 (27.1 %) cases, the conversion (laparotomy) have been done. Post-surgical mortality was 5 (3 %) cases. Our methods of laparoscopic bleeding control in case of injury of parenchymal organs using a polypropylene mesh allow to extend the list of indications for laparoscopic surgeries and increase their efficiency considerably. Having performed comparative analysis of the post-surgical course we may arrive to a conclusion that laparoscopy with further conversion, which prolongs the time of surgery, does not affect the results of treatment of patients with the closed abdominal concomitant injury. The cause of the absence of difference in the results of treatment of the patients who underwent laparotomy and patients who underwent conversion after laparoscopy, which extended the time of surgery was application of the cell salvage device Cell saver 5, which stipulated application of medical manipulation in the first minutes of laparoscopy amid the prominent hemoperitoneum and lasting bleeding from parenchymal organs, which stabilized to a considerable extent the hemodynamics of patients with the concomitant closed abdominal trauma, thus preventing development of a severe form of hemorrhagic shock. In contrast, compensation of blood loss was much slower and less effective during the laparotomy before the cell salvage device started to be used.