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Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis

Published:October 19, 2022DOI:https://doi.org/10.1016/j.jss.2022.09.015

      Abstract

      Introduction

      Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes.

      Methods

      We performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality.

      Results

      Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038)

      Conclusions

      In our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.

      Keywords

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      References

        • Rhee P.
        • Joseph B.
        • Pandit V.
        • et al.
        Increasing trauma deaths in the United States.
        Ann Surg. 2014; 260: 13-21
        • Pereira B.M.
        • Ogilvie M.P.
        • Gomez-Rodriguez J.C.
        • et al.
        A review of ureteral injuries after external trauma.
        Scand J Trauma Resusc Emerg Med. 2010; 18: 1-11
        • Bryk D.J.
        • Zhao L.C.
        Guideline of guidelines: a review of urological trauma guidelines.
        BJU Int. 2016; 117: 226-234
        • Pereira B.M.T.
        • De Campos C.C.C.
        • Calderan T.R.A.
        • Reis L.O.
        • Fraga G.P.
        Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view.
        World J Urol. 2013; 31: 913-917
        • Engelsgjerd J.S.
        • LaGrange C.A.
        Ureteral Injury.
        StatPearls Publishing, Treasure Island, FL2021
        • Morey A.F.
        • Brandes S.
        • Dugi D.D.
        • et al.
        Urotrauma: AUA guideline.
        J Urol. 2014; 192: 327-335
        • Mandrioli M.
        • Inaba K.
        • Piccinini A.
        • et al.
        Advances in laparoscopy for acute care surgery and trauma.
        World J Gastroenterol. 2016; 22: 668
        • Holevar M.
        • DiGiacomo C.
        • Ebert J.
        Practice Management Guidelines for the Management of Genitourinary Trauma.
        The EAST Practice Management Guidelines Work Group, Chicago, IL2011
        • Athanasiou C.D.
        • Robinson J.
        • Yiasemidou M.
        • Lockwood S.
        • Markides G.A.
        Laparoscopic vs open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes.
        Int J Surg. 2017; 41: 78-85
        • Martínez-Pérez A.
        • de’Angelis N.
        • Brunetti F.
        • et al.
        Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis.
        World J Emerg Surg. 2017; 12: 1-10
        • Sajid M.S.
        • Khawaja A.H.
        • Sains P.
        • Singh K.K.
        • Baig M.K.
        A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction.
        Am J Surg. 2016; 212: 138-150
        • Eskicorapci S.Y.
        • Teber D.
        • Schulze M.
        • Ates M.
        • Stock C.
        • Rassweiler J.J.
        Laparoscopic radical nephrectomy: the new gold standard surgical treatment for localized renal cell carcinoma.
        ScientificWorldJournal. 2007; 7: 825-836
        • Parikh R.R.
        • Patel A.
        • Kim S.
        • Kim I.Y.
        • Goyal S.
        Comparative effectiveness of laparoscopic versus open prostatectomy for men with low-risk prostate cancer: a matched case-control study.
        Int J Surg Oncol. 2017; 2: e13
        • Velanovich V.
        Laparoscopic vs open surgery.
        Surg Endosc. 2000; 14: 16-21
        • Li Y.
        • Xiang Y.
        • Wu N.
        • et al.
        A comparison of laparoscopy and laparotomy for the management of abdominal trauma: a systematic review and meta-analysis.
        World J Surg. 2015; 39: 2862-2871
        • Caroff D.A.
        • Chan C.
        • Kleinman K.
        • et al.
        Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery.
        JAMA Netw Open. 2019; 2: e1913570
        • Holzer A.
        • Jirecek S.T.
        • Illievich U.M.
        • Huber J.
        • Wenzl R.J.
        Laparoscopic versus open myomectomy: a double-blind study to evaluate postoperative pain.
        Anesth Analg. 2006; 102: 1480-1484
        • Di Saverio S.
        Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort.
        J Trauma Acute Care Surg. 2014; 77: 338-350
        • Culhane J.
        • Syed J.R.
        • Siddiqui S.
        Minimally invasive management versus open surgery in the treatment of penetrating bladder injuries: a retrospective cohort study.
        BMC Urol. 2021; 21: 1-6
        • Min J.-S.
        • Seo K.W.
        • Jeong S.-H.
        • et al.
        A comparison of postoperative outcomes after open and laparoscopic reduction of Petersen’s Hernia: a multicenter observational cohort study.
        BMC Surg. 2021; 21: 1-7
        • Ivatury R.R.
        • Simon R.J.
        • Stahl W.M.
        A critical evaluation of laparoscopy in penetrating abdominal trauma.
        J Trauma. 1993; 34 (discussion 827): 822-827
        • Como J.J.
        • Bokhari F.
        • Chiu W.C.
        • et al.
        Practice management guidelines for selective nonoperative management of penetrating abdominal trauma.
        J Trauma Acute Care Surg. 2010; 68: 721-733
        • Kindel T.
        • Latchana N.
        • Swaroop M.
        • et al.
        Laparoscopy in trauma: an overview of complications and related topics.
        Int J Crit Illn Inj Sci. 2015; 5: 196
        • Zantut L.F.
        • Ivatury R.R.
        • Smith R.S.
        • et al.
        Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.
        J Trauma Acute Care Surg. 1997; 42: 825-831
        • Velmahos G.C.
        • Degiannis E.
        • Wells M.
        • Souter I.
        Penetrating ureteral injuries: the impact of associated injuries on management.
        Am Surg. 1996; 62: 461-468
        • Perez-Brayfield M.R.
        • Keane T.E.
        • Krishnan A.
        • Lafontaine P.
        • Feliciano D.V.
        • Clarke H.S.
        Gunshot wounds to the ureter: a 40-year experience at grady memorial hospital.
        J Urol. 2001; 166: 119-121
        • Aimaq R.
        • Akopian G.
        • Kaufman H.S.
        Surgical site infection rates in laparoscopic versus open colorectal surgery.
        Am Surg. 2011; 77: 1290-1294
        • Kulkarni N.
        • Arulampalam T.
        Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis.
        Tech Coloproctol. 2020; 24: 1017-1024
        • Biondi A.
        • Di Stefano C.
        • Ferrara F.
        • Bellia A.
        • Vacante M.
        • Piazza L.
        Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness.
        World J Emerg Surg. 2016; 11: 1-6
        • Lujan J.
        • Parrilla P.
        • Robles R.
        • Marin P.
        • Torralba J.
        • Garcia-Ayllon J.
        Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study.
        Arch Surg. 1998; 133: 173-175
        • Ansari S.
        • Hassan M.
        • Barry H.D.
        • et al.
        Risk factors associated with surgical site infections: a retrospective report from a developing country.
        Cureus. 2019; 11: e4801