Dear Sir

We have analyzed the manuscript by Cerutti et al.¹ entitled: “Laparoscopic approach to abdominal trauma. Experience in a trauma hospital” with particular interest. The aim of this study was to describe the experience of a trauma hospital in diagnostic and therapeutic laparoscopy in trauma during 4 years and evaluate its usefulness. In this way, we would like to make the following considerations:

The authors point out that the retrospective and descriptive nature of their study was one of the main limitations. Thus, collection of data and variables may have been poorly checked or limited, and they do not mention how they checked for possible information biases inherent to the collection and review of clinical records. It is important to highlight that since the turn of the millennium, the performance of contrast-enhanced computed tomography (CT) has significantly improved, reflected in a higher incidence of isolated free fluid² which was previously considered a surrogate marker of possible hollow viscera injury undoubtedly requiring surgical intervention, as the authors accurately mention in their paper. However, nowadays, and because of these circumstances, the importance of isolated free fluid has been reevaluated, and instead of considering immediate surgical repair, Bekker et al.² decided conservative and watchful management for 48 hours since up to 90% of patients were successfully treated without the need for surgery.

Finally, we are aware that the benefits of laparoscopic surgery are well defined, but its implementation in low- and middle-income countries is still limited. Low-cost laparoscopy should be an essential component of cost-effective and innovative surgical research, and the reduction of cost overruns in both emergency and elective care settings will represent better and more robust findings³. We consider that the authors and Latin American surgeons should urgently and timely recognize the limitations of the studies they carry out and provide more specific and precise strategies to guide the institutions and surgical groups that still need to consolidate.

Jorge A. Castrillón-Lozano y Valeria López-Cardona

Dear Sir

Firstly, I would like to thank you for your interest in the article published by our group on the usefulness of laparoscopy in abdominal trauma.

Regarding the method of the study, we believe that prospective studies have higher scientific validity. Nevertheless, we conducted a retrospective study with conscious review of the medical records and with the cooperation of the Department of Statistics of our hospital to reduce the possibility of biases. Thus, we included all the patients who had undergone a laparoscopic approach over that period without selecting them. As for the presence of free fluid without solid organ injury in the computed tomography scan, I think it would be interesting to perform a study only focused on this topic, differentiating findings in open and blunt trauma.

The aim of our study was to describe our experience in laparoscopic surgery in trauma, since we belong to the largest trauma hospital in the region, and the high number of cases allowed us to count with a large sample. The conclusions are useful for further research and to encourage other surgical teams to safely use this approach in selected cases of trauma patients.

Clara Nair María Cerutti y José María López