Laparoscopic transdiaphragmatic pericardial window: Getting to the heart of the matter

Caitlin A. Smith, Joseph M Galante, Jonathan L Pierce, Lynette A. Scherer

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Penetrating wounds to the upper abdomen and lower precordium mandate exclusion of intra-abdominal and cardiac injuries. The most sensitive test to exclude cardiac injury is direct visualization of the pericardial fluid. Since 2001, we have examined the abdomen and performed transdiaphragmatic (central tendon) pericardial window via laparoscopy in stable patients at risk for both cardiac and peritoneal injuries. Study Design: At our Level I trauma center we reviewed consecutive patients who underwent evaluation of pericardial fluid after trauma between 2001 and 2008 and identified those patients in whom laparoscopic pericardial window was performed. We collected data on demographics, technique, findings, complications, and follow-up. Results: There were 393 patients who underwent diagnostic laparoscopy. Of those, 38 patients received laparoscopic transdiaphragmatic pericardial window. Six cardiac injuries (15.8%) were identified with 5 penetrating injuries to the right ventricle and 1 myocardial contusion. All 5 right ventricular injuries required median sternotomy for injury repair. None of the patients had significant hemodynamic compromise during operation. The pericardial window was left open in all patients, with no morbidity. The average length of stay for patients without chest tubes and a negative window was less than 24 hours. For patients with chest tubes, length of stay was 4.6 days. The interquartile range for follow-up was 21.5 to 315 days. Conclusions: Diagnostic laparoscopy with transdiaphragmatic pericardial window allows for thorough evaluation of both abdominal and cardiac injuries with a resultant short length of stay and no morbidity or mortality. In this, the largest series in the literature, laparoscopic pericardial window was a safe and effective modality to evaluate hemodynamically stable patients who are at risk for both cardiac and abdominal injuries.

Original languageEnglish (US)
Pages (from-to)736-742
Number of pages7
JournalJournal of the American College of Surgeons
Volume213
Issue number6
DOIs
StatePublished - Dec 2011

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Wounds and Injuries
Abdominal Injuries
Laparoscopy
Chest Tubes
Length of Stay
Abdomen
Penetrating Wounds
Morbidity
Sternotomy
Trauma Centers
Tendons
Heart Ventricles
Hemodynamics
Demography
Mortality
Pericardial Fluid

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic transdiaphragmatic pericardial window : Getting to the heart of the matter. / Smith, Caitlin A.; Galante, Joseph M; Pierce, Jonathan L; Scherer, Lynette A.

In: Journal of the American College of Surgeons, Vol. 213, No. 6, 12.2011, p. 736-742.

Research output: Contribution to journalArticle

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