Getting a Better Look: Outcomes of Laparoscopic versus Trans-Diaphragmatic Pericardial Window for Penetrating Thoracoabdominal Trauma at a Level I Trauma Center.

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. (C) 2016 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/29TRdu9