Getting a Better Look

Outcomes of Laparoscopic versus Trans-Diaphragmatic Pericardial Window for Penetrating Thoracoabdominal Trauma at a Level I Trauma Center

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Abstract

BACKGROUND: In penetrating thoracoabdominal trauma, it is necessary to evaluate both pericardial fluid and the diaphragm directly. Trans-diaphragmatic pericardial windows provide direct access to the pericardium and diaphragm, but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows are a safe and effective alternative to trans-diaphragmatic pericardial windows in stable patients. METHODS: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a Level I Trauma Center between January 2007 – June 2015, comparing outcomes after trans-diaphragmatic (TDW) versus laparoscopic pericardial windows (LPW). RESULTS: A total of 99 patients with penetrating trauma had a diagnostic pericardial window, 33 of which were laparoscopic. Stab wounds were most common (80, 80.8%), compared to gunshot wounds (19, 19.2%). Of 11 patients with a positive pericardial window, 10 (90.9.%) were associated with a cardiac injury. There was no difference in the ratio of positive pericardial windows between patients who had TDW vs. LPW (8/66, 12.1% vs. 3/33, 9.1%, p=0.651). One patient had a complication related to a negative pericardial window in the laparoscopic group. There was no difference in complication rates between TDW and LPW (p=0.155). Mean length of stay (LOS) was longer in TDW compared to LPW (12 vs. 5 days, p=0.046). One patient died during index admission in the TDW group, but there was no difference in mortality rates between TDW and LPW during the index admission (p=0.477). Median length of follow-up was 29 days (range 0-2,709). On long-term follow-up, there was also no difference in mortality rates between TDW and LPW (2/66, 3.0% vs. 2/33, 6.1%, p=0.470). CONCLUSION: In hemodynamically stable patients with thoracoabdominal injuries, LPW is a safe and effective technique for evaluating both pericardial fluid and the diaphragm. Laparoscopic pericardial window is a viable alternative to exploratory laparotomy and trans-diaphragmatic pericardial windows. LEVEL OF EVIDENCE: Level III.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Jul 6 2016

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Trauma Centers
Wounds and Injuries
Diaphragm
Laparotomy
Stab Wounds
Gunshot Wounds
Mortality
Pericardium
Observational Studies
Length of Stay
Retrospective Studies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

@article{a2c637f2388f4cfd996266f72f8c2610,
title = "Getting a Better Look: Outcomes of Laparoscopic versus Trans-Diaphragmatic Pericardial Window for Penetrating Thoracoabdominal Trauma at a Level I Trauma Center",
abstract = "BACKGROUND: In penetrating thoracoabdominal trauma, it is necessary to evaluate both pericardial fluid and the diaphragm directly. Trans-diaphragmatic pericardial windows provide direct access to the pericardium and diaphragm, but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows are a safe and effective alternative to trans-diaphragmatic pericardial windows in stable patients. METHODS: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a Level I Trauma Center between January 2007 – June 2015, comparing outcomes after trans-diaphragmatic (TDW) versus laparoscopic pericardial windows (LPW). RESULTS: A total of 99 patients with penetrating trauma had a diagnostic pericardial window, 33 of which were laparoscopic. Stab wounds were most common (80, 80.8{\%}), compared to gunshot wounds (19, 19.2{\%}). Of 11 patients with a positive pericardial window, 10 (90.9.{\%}) were associated with a cardiac injury. There was no difference in the ratio of positive pericardial windows between patients who had TDW vs. LPW (8/66, 12.1{\%} vs. 3/33, 9.1{\%}, p=0.651). One patient had a complication related to a negative pericardial window in the laparoscopic group. There was no difference in complication rates between TDW and LPW (p=0.155). Mean length of stay (LOS) was longer in TDW compared to LPW (12 vs. 5 days, p=0.046). One patient died during index admission in the TDW group, but there was no difference in mortality rates between TDW and LPW during the index admission (p=0.477). Median length of follow-up was 29 days (range 0-2,709). On long-term follow-up, there was also no difference in mortality rates between TDW and LPW (2/66, 3.0{\%} vs. 2/33, 6.1{\%}, p=0.470). CONCLUSION: In hemodynamically stable patients with thoracoabdominal injuries, LPW is a safe and effective technique for evaluating both pericardial fluid and the diaphragm. Laparoscopic pericardial window is a viable alternative to exploratory laparotomy and trans-diaphragmatic pericardial windows. LEVEL OF EVIDENCE: Level III.",
author = "Jamie Anderson and Edgardo Salcedo and Rounds, {Kacie M.} and Galante, {Joseph M}",
year = "2016",
month = "7",
day = "6",
doi = "10.1097/TA.0000000000001173",
language = "English (US)",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Getting a Better Look

T2 - Outcomes of Laparoscopic versus Trans-Diaphragmatic Pericardial Window for Penetrating Thoracoabdominal Trauma at a Level I Trauma Center

AU - Anderson, Jamie

AU - Salcedo, Edgardo

AU - Rounds, Kacie M.

AU - Galante, Joseph M

PY - 2016/7/6

Y1 - 2016/7/6

N2 - BACKGROUND: In penetrating thoracoabdominal trauma, it is necessary to evaluate both pericardial fluid and the diaphragm directly. Trans-diaphragmatic pericardial windows provide direct access to the pericardium and diaphragm, but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows are a safe and effective alternative to trans-diaphragmatic pericardial windows in stable patients. METHODS: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a Level I Trauma Center between January 2007 – June 2015, comparing outcomes after trans-diaphragmatic (TDW) versus laparoscopic pericardial windows (LPW). RESULTS: A total of 99 patients with penetrating trauma had a diagnostic pericardial window, 33 of which were laparoscopic. Stab wounds were most common (80, 80.8%), compared to gunshot wounds (19, 19.2%). Of 11 patients with a positive pericardial window, 10 (90.9.%) were associated with a cardiac injury. There was no difference in the ratio of positive pericardial windows between patients who had TDW vs. LPW (8/66, 12.1% vs. 3/33, 9.1%, p=0.651). One patient had a complication related to a negative pericardial window in the laparoscopic group. There was no difference in complication rates between TDW and LPW (p=0.155). Mean length of stay (LOS) was longer in TDW compared to LPW (12 vs. 5 days, p=0.046). One patient died during index admission in the TDW group, but there was no difference in mortality rates between TDW and LPW during the index admission (p=0.477). Median length of follow-up was 29 days (range 0-2,709). On long-term follow-up, there was also no difference in mortality rates between TDW and LPW (2/66, 3.0% vs. 2/33, 6.1%, p=0.470). CONCLUSION: In hemodynamically stable patients with thoracoabdominal injuries, LPW is a safe and effective technique for evaluating both pericardial fluid and the diaphragm. Laparoscopic pericardial window is a viable alternative to exploratory laparotomy and trans-diaphragmatic pericardial windows. LEVEL OF EVIDENCE: Level III.

AB - BACKGROUND: In penetrating thoracoabdominal trauma, it is necessary to evaluate both pericardial fluid and the diaphragm directly. Trans-diaphragmatic pericardial windows provide direct access to the pericardium and diaphragm, but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows are a safe and effective alternative to trans-diaphragmatic pericardial windows in stable patients. METHODS: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a Level I Trauma Center between January 2007 – June 2015, comparing outcomes after trans-diaphragmatic (TDW) versus laparoscopic pericardial windows (LPW). RESULTS: A total of 99 patients with penetrating trauma had a diagnostic pericardial window, 33 of which were laparoscopic. Stab wounds were most common (80, 80.8%), compared to gunshot wounds (19, 19.2%). Of 11 patients with a positive pericardial window, 10 (90.9.%) were associated with a cardiac injury. There was no difference in the ratio of positive pericardial windows between patients who had TDW vs. LPW (8/66, 12.1% vs. 3/33, 9.1%, p=0.651). One patient had a complication related to a negative pericardial window in the laparoscopic group. There was no difference in complication rates between TDW and LPW (p=0.155). Mean length of stay (LOS) was longer in TDW compared to LPW (12 vs. 5 days, p=0.046). One patient died during index admission in the TDW group, but there was no difference in mortality rates between TDW and LPW during the index admission (p=0.477). Median length of follow-up was 29 days (range 0-2,709). On long-term follow-up, there was also no difference in mortality rates between TDW and LPW (2/66, 3.0% vs. 2/33, 6.1%, p=0.470). CONCLUSION: In hemodynamically stable patients with thoracoabdominal injuries, LPW is a safe and effective technique for evaluating both pericardial fluid and the diaphragm. Laparoscopic pericardial window is a viable alternative to exploratory laparotomy and trans-diaphragmatic pericardial windows. LEVEL OF EVIDENCE: Level III.

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DO - 10.1097/TA.0000000000001173

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JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

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