title: Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.
abstract: BACKGROUND
  Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited.
  
  
  METHODS
  Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy.
  
  
  RESULTS
  Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor.
  
  
  CONCLUSIONS
  Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.
authors.affiliation: Department of Surgery, University of Sao Paulo, Brazil.
authors.forename: L F
authors.initials: LF
authors.lastname: Zantut
authors.forename: R R
authors.initials: RR
authors.lastname: Ivatury
authors.forename: R S
authors.initials: RS
authors.lastname: Smith
authors.forename: N T
authors.initials: NT
authors.lastname: Kawahara
authors.forename: J M
authors.initials: JM
authors.lastname: Porter
authors.forename: W R
authors.initials: WR
authors.lastname: Fry
authors.forename: R
authors.initials: R
authors.lastname: Poggetti
authors.forename: D
authors.initials: D
authors.lastname: Birolini
authors.forename: C H
authors.initials: CH
authors.lastname: Organ
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery*