Лапароскопія під час лікування проникної та тупої травм живота (систематичний огляд)

The role of diagnostic and therapeutic laparoscopy in abdominal trauma has expanded over the last decade, but indications, safety, and comparative effectiveness versus laparotomy remain debated. Recent data, including large multicentre cohorts and updated meta-analyses, justify a focused synthesis. Aim. To systematically review contemporary evidence on the effectiveness and safety of laparoscopy for the management of penetrating and blunt abdominal trauma, including case reports published over the last five years. Materials and methods. Following PRISMA 2020 guidance, we searched PubMed / MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar. We included prospective/retrospective clinical studies and case series evaluating laparoscopy in abdominal trauma. Primary outcomes included non-therapeutic laparotomy (NTL) rates, missed injuries, complications, conversion rates, length of stay (LOS), and mortality. Risk of bias was assessed using ROBINS-I for non-randomized studies and descriptive appraisal for case reports. Results. The search has identified two recent systematic reviews / meta-analyses on abdominal trauma (one blunt-specific, one mixed blunt/penetrating), several cohort / propensity-matched studies (including large registry analyses), and multiple single-center series and case reports published during 2020–2025. Laparoscopy in hemodynamically stable trauma patients consistently reduced NTL (19 % absolute reduction in a large single-center series) and postoperative complications and shortened LOS compared with laparotomy, without increasing missed injuries or mortality. Multicenter registry data for blunt trauma and recent retrospective cohorts showed that laparoscopic intervention in selected patients did not increase in-hospital mortality and was associated with acceptable conversion and complication rates. Case reports and small series document successful laparoscopic management of complex injuries (diaphragmatic rupture, hollow viscus injuries, colon trauma, post-traumatic hernias) in both blunt and penetrating mechanisms, with low morbidity in carefully selected patients. Conclusions. The accumulated evidence strongly supports the role of laparoscopy in the management of penetrating and blunt abdominal trauma in hemodynamically stable patients. The use of laparoscopy in trauma management significantly reduces the rate of non-therapeutic laparotomies and postoperative complications and shortens hospital stays. Laparoscopy for abdominal trauma maintains very low rates of missed injuries and mortality when applied with strict patient selection and surgeon expertise.