Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma.
BACKGROUND
Our institution was one of the first to report the use of laparoscopy in the management of penetrating abdominal trauma (PAT) in 1977. Despite early interest, laparoscopy was rarely used. Changes in 1995 resulted in an increase in interest and use of laparoscopy. We present our recent experience with laparoscopy.


METHODS
Our trauma registry and operative log were used to identify patients with blunt and penetrating injuries to the abdomen, back, and flank who underwent laparotomy or laparoscopy during the past 5 years. Patient demographics, operative findings, complications, and length of stay were reviewed. The number of laparoscopic explorations, therapeutic, nontherapeutic, and negative laparotomies were trended.


RESULTS
There were 429 abdominal explorations for trauma. The rate of laparoscopy after penetrating injury increased from 8.7% to 16%, and after stab wounds from 19.4% to 27%. There was an associated decrease in the negative laparotomy rate. Laparoscopy prevented unnecessary laparotomy in 25 patients with PAT. Four patients with diaphragm injuries underwent repair laparoscopically.


CONCLUSIONS
An aggressive laparoscopic program can improve patient management after PAT.
Simon
Ronald J
RJ
Department of Surgery, Jacobi Medical Center, Bronx, New York 10461, USA. traumamd@nyc.rr.com
Rabin
Joseph
J
Kuhls
Deborah
D
D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D009519:New York City; D012189:Retrospective Studies; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery*; D014951:Wounds, Stab / Q000175:diagnosis / Q000601:surgery