a human being exposes himself to a variety of injuries caused by numerous forces like vehicular accident , social conflict , terrorism , crimes , wars , industrial accident and fall from a height .
the commonly injured organs are the liver , spleen , kidney , intestines , stomach , pancreas , urinary bladder and vessels .
previously all patients with bta ended up in laparotomy and were managed according to the organ injuries .
the advent and development of new techniques like laparoscopy  minimally invasive surgery ( mis )  have a diagnostic as well as definitive therapeutic role in bta . the availability of sophisticated instruments , equipments and expert anaesthesiologists make laparoscopy an attractive technique for diagnostic and therapeutic measures in bta .
haemoperitoneum with stable vitals and injury to the liver , spleen , bowel , mesentery and bladder can be managed by laparoscopy .
advanced laparoscopic techniques include bowel resection and anastomosis , ligation of blood vessels can be as efficiently utilised in bta as an elective open surgery.[35 ] one can visualise the peritoneal cavity and act expeditiously if needed ( i.e. , laparotomy , laparoscopic - assisted intervention , or only observation ) at the time of laparoscopy .
this study was planned with the objective of evaluating the therapeutic efficacy of laparoscopy in managing the organ damage in bta .
after institutional ethical committee approval and informed written consent from the patients , a prospective randomised clinical study was carried out in 25 adult patients of either sex , scheduled for laparoscopic intervention in the surgical ward of the government medical college and sir t. hospital , bhavnagar .
patients who sustained haemoperitoneum , confirmed in ultrasonography ( usg ) or computed tomogram ( ct scan ) , with relatively stable haemodynamics , were enrolled in this study ( blood pressure > 80 mm of mercury systolic and > 15 ml / hour urine output ) .
patients with unstable haemodynamics , even after three units of whole blood transfusion ( 1 unit = 300 cc ) and associated edh ( extradural haemorrhage ) / sdh ( subdural haemorrhage ) , compound fracture , spine fracture , severe chest injury with low spo2 ( < 90% ) , haemodynamically unstable , anticipated difficult endotracheal intubation and pregnancy , were excluded .
the three main ports are : 
 umbilical port ( 10 mm)right - sided port ( 5 mm / 10 mm )  lumbar at anterior axillary lineleft - sided port ( 5mm/10 mm )  lumbar at anterior axillary lineextra port , if required , is made according to the organ injury usually in the subxiphoid region or in the lower abdomen . 
 
umbilical port ( 10 mm ) right - sided port ( 5 mm / 10 mm )  lumbar at anterior axillary line left - sided port ( 5mm/10 mm )  lumbar at anterior axillary line extra port , if required , is made according to the organ injury usually in the subxiphoid region or in the lower abdomen . if no complex injuries are found and the patient is haemodynamically stable , focussed therapeutic laparoscopic intervention is done , such as , primary closure of the bowel perforation , primary repair of the bladder rupture in two layers , electrocauterization and spraying of feracryline ( hemolock ) solution at the injury site on the liver and spleen ( contusion , laceration or tear ) , with no active bleeding , without disturbing the preformed hematoma.[81114 ]
the three main ports are : 
 umbilical port ( 10 mm)right - sided port ( 5 mm / 10 mm )  lumbar at anterior axillary lineleft - sided port ( 5mm/10 mm )  lumbar at anterior axillary lineextra port , if required , is made according to the organ injury usually in the subxiphoid region or in the lower abdomen . 
 
umbilical port ( 10 mm ) right - sided port ( 5 mm / 10 mm )  lumbar at anterior axillary line left - sided port ( 5mm/10 mm )  lumbar at anterior axillary line extra port , if required , is made according to the organ injury usually in the subxiphoid region or in the lower abdomen . if no complex injuries are found and the patient is haemodynamically stable , focussed therapeutic laparoscopic intervention is done , such as , primary closure of the bowel perforation , primary repair of the bladder rupture in two layers , electrocauterization and spraying of feracryline ( hemolock ) solution at the injury site on the liver and spleen ( contusion , laceration or tear ) , with no active bleeding , without disturbing the preformed hematoma.[81114 ]
demographic profile of patients laparoscopic intervention required in different patients laparoscopic intervention required in blunt trauma abdomen data suggested that two - thirds of the cases are due to road traffic accidents [ figures 15 ] .
splenic laceration near hilum ( grade-2 injury ) laparoscopic urinary bladder repair post laparoscopy scar on discharge drain placement in the right sub - diaphragmatic space in a liver injury in the present study a total of 25 cases of bta were studied , out of which 24 cases ( 96% ) were managed laparoscopically and one was converted into an open mini - laparotomy .
graph 1 suggests different organ injuries in bta , liver being the most common in our study , in contrast to western countries where the spleen is the most common .
no injuries were detected in two patients other than the non - expanding retroperitoneal haematomas which were left untouched .
hence , the diagnostic value of laparoscopy ( 98% ) has a tremendous value , which corresponds to the hamish foster series ( 89% ) with zero% negative laparotomy . with 04% failure rates , a single laparoscopy is converted into a mini - laparotomy , for large ileal perforation and hematoma , and managed by resection and anastomosis with the help of a small umbilical port cosmetic incision .
another single patient , who was referred to a higher centre of management of pulmonary embolism on the first post - operative day , not maintaining spo2 even with 6 l of o2 support , due to pulmonary embolism , was not included in the study .
table 4 reveals the post - operative management in patients of bta treated by laparoscopy and supports the conclusion .
post - operative management practically no complication was found related to laparoscopy in present study .
in second and third decade of life the liver and spleen are common organs involved in bta . with the advent of the current laparoscopy
laparoscopy provides early mobilisation , early oral intake , fast recovery , early resumption of work , reduced post - operative stay in the hospital and analgesic requirement , with early discharge as compared to laparotomy .
limitations : it requires sophisticated instruments and general anaesthesia ; hemodynamic stability of the patient , poor visualisation of the seventh and eighth segments of the liver , posterior surface spleen , retroperitoneal organ , pancreas and second part of duodenum .
the question addressed by this study is whether introduction of an aggressive laparoscopy programme would find its acceptance , and will it make a difference or not ?
our data clearly shows that this indeed will occur , however , it requires a further , prolonged , prospective study for obtaining an even better conclusion and interpretation . with advancement in equipment , more people getting trained and the surgeon 's being able to perform technically difficult manoeuvres laparoscopically , it appears that laparoscopy is now closer to replacing emergency laparotomy in the forthcoming future , for the management of blunt abdominal injury .
 background : laparoscopy is safe and effective in the management of blunt trauma abdomen ( bta ) with haemoperitoneum , with all benefits of minimal access surgery.aims:to study the incidence of organ damage and post - operative care in patients of blunt abdominal trauma with haemoperitoneum , managed by a new modality of treatment  laparoscopy.materials and methods : prospectively collected data on laparoscopy performed in patients with blunt abdominal injury , between the years 2004 to 2006 , were analysed . under general anaesthesia pneumoperitoneum 
 was created . a 10 mm umbilical port , right - sided port in the anterior axillary line ( 5 mm / 10 mm ) , left - sided port in the anterior axillary line ( 5 mm / 10 mm ) and an extra port were made according to the organ injury , and laparoscopy was performed and managed according to the organ injury.result:twenty-five patients had laparoscopy for blunt trauma abdomen with haemoperitoneum . 
 liver followed by the spleen were the most common sites of injuries . 
 the overall failure rate was 4% . 
 post - operative stay and complications were much less . 
 laparoscopy reduced the number of negative laparotomies , with a limitation that it could not be performed in haemodynamically unstable patients.conclusion:the liver and spleen are the most common organs involved in patients with blunt abdominal trauma with haemoperitoneum . 
 laparoscopy is safe and efficient in patients with blunt trauma abdomen with haemoperitoneum , with fast recovery and low hospital stay . 