THE COMPLICATIONS OF NEGATIVE LAPAROTOMY AT BLUNT AND PENETRATING ABDOMINAL INJURIES

It is still an issue of debate that just how much the rate of negative laparotomy should be in cases of blunt and penetrating abdominal injuries. The rate of explorative laparotomy with negative findings is especially high in patients with minimal symptoms and signs where the existence of an actual organic injury is doubt. Recently, routine preoperative invasive and non-invasive tests and application of various techniques of intraabdominal visualization have caused a significant drop in the rate of negative laparotomy. But this may create a false feeling of security and may cause a rise in the morbidity and mortality through neglection. Being conservative may be hazardous in some as being invasive yet in another. Therefore at the Surgery Clinic of Taksim Hospital out of a pool of 358 patients with blunt and penetrating abdominal injuries we followed the occurrence of early morbidity and mortality in a total of 53 patients with negative laparotomy. 31 patients had blunt and 22 penetrating trauma. 22 patients (%38) had additional systematic and organic injuries. Patients were divided in two groups: one with pure abdominal and another with abdominal and extraabdominal injuries. Both groups were compared in relation to the occurence of major complications such as atelectasis, pneumonia and intestinal obstruction and minor ones such as phlebitis and wound infection. Results were analyzed with the Fisher's exact t test. The use of local exploration and peritoneal lavage in penetrating and peritoneal lavage and computed tomography in blunt injuries have caused a dramatic decrease in the rate of negative laparotomy. But in patients with especially blunt trauma who poses some signs of intraabdominal injury the easiest and the most quick method of evaluation is explorative laparotomy. The morbidity of this procedure is measurable and minimal.

KÜNT VE PENETRAN ABDOMÝNAL YARALANMALARDA NEGATÝF LAPAROTOMÝ KOMPLÝKASYONLARI

Künt ve penetran abdominal travmalarda, negatif laparotominin kabul edilebilirliliðinin, ne oranda olmasý gerektiði halen tartýþýla gelen bir konudur. Özellikle organ yaralanmasý bulgularýnýn minimal olduðu ve yaralanmanýn þüpheli kaldýðý olgularda rutin araþtýrýcý laparotomi tatbiki yüksek negatif laparotomi ile birliktedir. Bu hastalarda laparotomi öncesi invaziv ve noninvaziv testler ve görüntüleme yöntemleri uygulanmakla negatif oranýnda önemli bir azalma olmuþtur. Buna karþýlýk bu testlerin yaratabileceði güven ortamý, gözden kaçabilecek yaralanmalar nedeni ile, morbidite ve mortalitede artýþa yol açabilir. Dolayýsýyla kunt ve penetran yaralanmalarda laparotomi uygulamak gibi konservatif kalmak da bir risk taþýmaktadýr. Bu nedenle biz Taksim Hastanesi I. Cerrahi Kliniði'nde erken morbidite ve mortalite açýsýndan, 358 künt ve penetran travmalý olgu içinden, 53 negatif laparotomi uygulanan hastayý 2-33 aylýk süre içinde takip ettik. 31 'i penetran, 22 'si künt travmaya karþý kalan hastalarýn 22 (%38) 'sinde ilave sistem ve organ yaralanmasý mevcuttu. Hastalar saf abdominal yaralanmak ve abdomen dýþý yaralanma da mevcut olanlar olmak üzere iki gruba ayrýldý. Gruplar atelektazi, pnömoni ve intestinal obstrüksiyon (majör), flebitis ve yara infeksiyonu (minör) gibi komplikasyonlar geliþimi yönünden kýyaslandý. Sonuçlar Fisherin exact t testi ile deðerlendirildi. Penetran yaralanmalarda lokal eksplorasyon ve peritoneal lavaj, künt travmalarda, peritoneal lavaj ve bilgisayarlý tomografinin uygulanmasý ile negatif laparotomi sayýlarýnda önemli bir azalma olmuþtur. Fakat intraabdominal organ yaralanmasý bulgularý olan yaralanmalarda, özellikle künt travmalarda batýn içi yaralanmanýn ekarte edilmesinin en kolay ve hýzlý yöntemi araþtýrýcý laparotomidir. Bu olayýn morbiditesi ölçülebilir ve minimaldir.