Laparoscopy at Sebokeng Hospital with Emphasis on Trauma
Advances in minimal access surgery has revolutionized the practice of surgery over the past two decades. In some areas, laparoscopy has become the standard of care as in cholecystectomy. Laparoscopy in trauma however has been trailing behind, supposedly because of the fear of missing injuries in unpredictable trauma setting. There are reports in the literature about the benefit of laparoscopy in trauma, but we do not have local data in South Africa. We therefore endeavour to assess the place of laparoscopy in trauma by performing this audit of our laparoscopy practice at Sebokeng Hospital, South Africa. Objective: Review of the practice of Laparoscopy at Sebokeng Hospital with special emphasis on trauma to identify the indications of laparoscopy in the management of selected injuries. Methods: Retrospective review of data from all laparoscopic procedures performed between November 2011 and October 2012 at Sebokeng Hospital. Parameters evaluated included demography, mechanism of injury, procedure and intra-operative findings. Result: A total of 390 laparoscopic procedures were performed. Majority were emergency 77.9% (304/390) topped by appendicectomy 54.9% (167/304) whilst trauma represented 13.8% (42/304) of all emergencies. Cholecystectomy was the most common elective procedure 74.4% (64/86). Of the trauma cases, 40 were available for analysis; the patients were predominantly male (36/40) and stable penetrating trauma was the most common indication (34/40) for surgery. Laparoscopy was successfully completed in 65% (26/40) of the patients. The remaining cases benefited from conversion 17.5% (7/40), laparoscopy assisted mini-laparotomy 15% (6/40) and laparoscopy guided referral to tertiary Hospital 2.5% (1/40). Conclusion: Laparoscopy is applicable in trauma in carefully selected cases obviating the need for unnecessary laparotomy with its related early and long term complications.
