COMPARISON OF OPEN AND CLOSED LAVAGE TECHNIQUES IN BLUNT AND PENETRATING ABDOMINAL TRAUMA

During a three year period patients seen following blunt and penetrating abdominal trauma were managed either with closed or with open lavage technique in a prospective and randomised manner of the 189 patients undergoing DPL 102 of them were accomplished with the open and the remaining 87 with the closed technique. 134 patients had blunt and 55 penetrating abdominal trauma. Applied technique, lavage time, active operation time, volume of aspirated fluid, results of microscopic examination, operative findings and complications were recorded for each patient. Comparisons were made with Fisher's exact t-test. In open DPL group, lavage time for grossly positive and microscopically positive cases were 11±8 mm. (3-24) and 22±16 min (8-55) respectively. The same numbers for the closed group were 3±2 min. (1-10) for the grossly and 24±9 min (11-47) for the microscopically positives. The difference in lavage time of grossly positives between the open and closed technique groups was slightly significant (p<0.05). Active operation time for open and closed groups were 12± 7 min. (4-37) and 4±2 min. (1-21) respectively (p<0.05). There was no significant difference between the volumes of re-aspirated fluid between the two techniques. Considering the results of this study we think the closed technique with its quick and easy application and better patient toleration to be the primary choice in cases of abdominal trauma in whom some form of DPL appears to be necessary.

KÜNT VE PENETRAN KARIN TRAVMALARINDA KAPALI VE AÇIK LAVAJ TEKNÝKLERÝNÝN KIYASLANMASI

3 yýllýk sürede, künt veya penetran batýn travmasý nedeniyle, acil baþvuran hastalara, prospektif ve randomize olarak açýk ve kapalý tekniklerle lavaj uyguladýk. 134'ü künt, 55'i penetran travmaya karþý kalan 189 hastadan 102'sine açýk, 87'sine kapalý (perkütan) teknikle lavaj yapýldý. Her hastada, uygulanan teknik, lavaj için gereken zaman aktif operasyon süresi, geriye alýnabilen sývý miktarý, mikroskopik sonuçlar, aperatif bulgular ve komplikasyonlar kaydedildi. Sonuçlar Fisher'in exact t testi ile deðerlendirildi. Açýk DPL grubunda belirgin pozitif lavaj süresi ortalama 11±8 dk. (3-24), kapalý grupta ise 3±2 dk.(1-10) oldu (p<0.05). Mikroskopik pozitif lavaj ise açýk grupta 22±16 dk. (8-55), kapalý grupta 24±9 dk. (11-47) bulundu. Bu iþlem esnasýnda harcanan aktif operasyon süresi açýk grupta 12±7 dk. (4-37), kapalý grupta ise 4±2 dk. (1-21) oldu (p<0.05). Geri alýnan sývý miktarý açýsýndan gruplar arasýnda anlamlý bir fark bulunamadý. Çalýþma sonuçlarý göz önüne alýnýnca, kapalý metodun ilk uygulama kolaylýðý ve hastalarýn daha rahat talere etmeleri, gerekse kazandýrdýðý zaman faktörü çerçevesinde ilk tercih edilmesi gereken teknik olduðuna inanýyoruz.