Kim DH, et al. Ann Surg Treat Res. 2021 Feb;100(2):76-85. https://doi.org/10.4174/astr.2021.100.2.76

Background The role of laparoscopy in the treatment and diagnosis of penetrating thoraco-abdominal injury has been established. However, there is no clear consensus on the role of laparoscopy in blunt injury due to numerous reasons, such as concerns of missed injury and technical problems in treating various abdominal organs. This study aimed to determine the feasibility of laparoscopy and evaluate its safety in managing blunt and penetrating abdominal trauma. Methods The medical records and Korean Trauma Data Base (KTDB) of patients who underwent abdominal surgery from January 2018 to December 2022 at a single level I center were collected. Patients were classified into a laparoscopy group and a laparotomy group. The laparoscopy groups were matched 1:1 with the laparotomy group by using propensity score matching (PSM). Patient demographics, injured organ and its grade, operative procedure, and postoperative outcomes were evaluated and compared between the two groups. Results After propensity score matching, 128 patients were included. There was no significant imbalance in demographics between the two groups except sex. Injured organ and its grade showed no significant differences between the two groups except for the incidence of omentum. Small bowel and mesenteric repair were performed most often in both groups. Splenectomy, pancreatic surgery, duodenectomy, and liver resection were performed exclusively in the laparotomy group. Severe postoperative complication rate (3% vs. 20%: p = 0.004), length of stay in ICU (3.3 ± 3.2 days vs. 4.6 ± 3.7; p = 0.046), and operation time (93.9 ± 47.7 min vs. 112.8 ± 57.7; p = 0.046) were significantly lower in the laparoscopy group. The conversion rate was about 16%. There was no missed injury. Conclusions In hemodynamically stable abdominal trauma patients who sustained penetrating or blunt injury, laparoscopy is feasible and safe as a diagnostic and therapeutic modality in selected cohort of abdominal trauma.

Background: Ultrasound is an attractive modality for the confirmation of sternal fractures in patients with trauma because of its easy, quick, and accurate nature, as well as its increased availability for focused assessment with sonography for trauma at the bedside. We aimed to confirm the diagnostic value of ultrasonography for sternal fractures in patients with trauma, anterior chest wall pain, and tenderness. Methods: This retrospective observational study included patients visiting a single regional trauma center from March 2022 to February 2023, diagnosed with sternal fractures via chest CT and bone scans, who underwent sternal ultrasound. Results: Twenty-six patients were divided into two groups: those with sternal fractures diagnosed with an initial chest CT scan (n = 19) and those without fractures (n = 7). Using ultrasound, 23 patients (88.5%) were diagnosed with sternal fractures. In the initial CT scan (+) group, all 19 patients (100%) were diagnosed using ultrasound. In the initial CT scan (−) group, four (57.1%) of the seven patients were diagnosed using ultrasound. In the initial CT scan (+) group, 14 (73.7%) of the 19 patients underwent bone scans and all 14/14 (100%) were diagnosed with sternal fractures. In the initial CT scan (−) group, seven (100%) patients underwent bone scans, and all were diagnosed with sternal fractures. Conclusions: Ultrasound is useful for the diagnosis of sternal fractures, with sensitivity of 88.5%. Therefore, in patients with blunt trauma experiencing anterior chest wall pain and tenderness, sternal ultrasonography might be helpful in diagnosing sternal fractures as an adjunct to chest CT and bone scans.

Purpose: The present study aimed to assess the incidence and risk factors of postoperative nausea and vomiting (PONV) after emergency abdominal surgery in trauma patients.Methods: This retrospective observational study included trauma patients who underwent emergency abdominal surgery at two trauma centers between January 2024 and May 2025. Medical records were reviewed according to the occurrence of PONV.Results: A total of 114 patients were included in the analysis, of whom 35 patients (30.7%) developed PONV. Patients with a history of PONV had a higher incidence of PONV than those without such a history (80% vs. 28.4%; P=0.030). The lymphocyte percentage was lower in the PONV group (27.8% vs. 20.0%; P=0.023). In binary logistic regression analysis, previous PONV (B=2.469, P=0.033; odds ratio [OR], 11.807; 95% confidence interval [CI], 1.224–113.897) and lymphocyte percentage (B=−0.034, P=0.021; OR, 0.967; 95% CI, 0.939–0.995) were significant risk factors. PONV severity was also associated with a higher segmented neutrophil percentage, a higher neutrophil-to-lymphocyte ratio, and a lower lymphocyte percentage.Conclusion: The incidence of PONV was 30.7%. Previous PONV and a lower lymphocyte percentage were identified as risk factors for PONV after emergency abdominal surgery in trauma patients. Further studies are needed to develop strategies for reducing PONV in this population.

Objective: To evaluate the viability and impact of South Korea’s inaugural Military-Civilian Partnership (MCP) pilot program in overcoming peacetime volume deficits and enhancing military clinical readiness. Methods: Over a 1-year period (September 2024-August 2025), an active-duty military surgeon maintained regular duties at a military facility, completing 65 shifts, while performing 41 intermittent 24-hour shifts at a civilian regional trauma center (RTC). The patient demographics, injury severity, and procedural/surgical volumes of the surgeon’s cases were retrospectively analyzed. Results: The surgeon managed 103 and 193 patients at the military facility and civilian RTC, respectively. The civilian RTC presented a significantly higher burden of severe trauma, with more patients presenting with Injury Severity Score (ISS) >9 (49% vs 35%, P = 0.023) and ISS >15 (35% vs 23%, P = 0.035). While the civilian RTC provided a higher volume of invasive procedures (142 vs 23) and complex visceral repairs, the military facility uniquely exposed the surgeon to military-specific mechanisms (gunshots, blasts) and preserved baseline dexterity through unrestricted general surgery access. Conclusions: These results suggest that a tailored, intermittent MCP model effectively sustains military clinical readiness by blending high-density civilian trauma exposure with military-specific trauma care.

Purpose: Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons.Methods: We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes.Results: Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed.Conclusions: There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.