Diagnostic and therapeutic laparoscopy for stab wounds of the anterior abdomen.
BACKGROUND
At present, laparoscopy is used mainly as a diagnostic tool in patients with abdominal stab wounds.


METHODS
Thirty-two hemodynamically stable patients with isolated stab wounds of the anterior abdomen, thought to be penetrating, were prospectively selected to undergo treatment via a laparoscopic approach. When possible, parenchymal wounds were coagulated or sealed, and wounds to the intestines were sutured or stapled.


RESULTS
The results of laparoscopy were negative in 6 (18.8%) of the cases: nonpenetrating wounds in 4 cases and nonsignificant organ injury in 2 cases. A hemoperitoneum was identified in 13 (40.6%) of the cases, and significant organ injuries in 26 (81.3%) of the cases: stomach, 2; small bowel, 5; colon, 2; pancreas, 1; vascular injuries, 4; liver, 5; mesentery, 9. Laparoscopy was therapeutic in 20 (62.3%) of the cases. Conversion to open surgery was required in 6 (18.8%) of the cases. No injuries were missed, and no mortality occurred. Postoperative complications developed in 2 (6.2%) of the cases. The mean hospital stay was 4 days, with no late complications.


CONCLUSIONS
Laparoscopy can avoid a number of unnecessary laparotomies and can treat most of the lesions found in hemodynamically stable patients with anterior abdominal stab wounds.
Fabiani
Pascal
P
Service de Chirurgie Digestive, Hôpital Archet 2, Nice, France. chir-digestive@chu-nice.fr
Iannelli
Antonio
A
Mazza
Davide
D
Bartels
Anne-Marie
AM
Venissac
Nicolas
N
Baqué
Patric
P
Gugenheim
J
J
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006465:Hemoperitoneum / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007421:Intestine, Small / Q000293:injuries; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000175:diagnosis* / Q000601:surgery*