The contribution of laparoscopy in evaluation of penetrating abdominal wounds.
BACKGROUND
Penetrating abdominal wounds are traditionally explored by laparotomy. We investigated prospectively the role of laparoscopy within a defined protocol for management of penetrating abdominal wounds to determine its safety and advantages over traditional operative management.


METHODS
The study inclusion criteria were: stab and gun shot abdominal wounds, including junction zone injuries; stable vital signs; and absence of contraindications for laparoscopy. Diagnostic end points included detection of peritoneum or diaphragm violation, visceral injuries, and other indications for laparotomy. Systematic examination was undertaken using a multiport technique whenever the peritoneum or diaphragm had been violated. All repairs were done by open operation.


RESULTS
A total of 40.6% of patients with penetrating trauma fulfilled study criteria (52 patients). Of these, 33% had no peritoneal penetration; 29% had no visceral injuries despite violation of peritoneum or diaphragm; 38% had visceral injuries, of which 40% (mainly liver and omentum) required no intervention. Twelve patients (23% of total) had open repairs. No missed injuries or death occurred in the study. Overall, 77% of penetrating injuries with stable vital signs avoided exploratory laparotomy. Compared with National Trauma Data Bank information for patients with the same Injury Severity Scores, hospitalization was reduced by more than 55% for the entire series.


CONCLUSIONS
Laparoscopy for penetrating abdominal injuries in a defined set of conditions was safe and accurate, effectively eliminating nontherapeutic laparotomy and shortening hospitalization.
Ahmed
Naveed
N
Department of Surgery, Huron Hospital, Cleveland Clinic Health System, Cleveland, OH 44112, USA.
Whelan
Jim
J
Brownlee
John
J
Chari
Vedantum
V
Chung
Raphael
R
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000465:Algorithms; D003663:Decision Trees; D017721:Hospital Costs / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008751:Methylene Blue; D018579:Patient Selection; D010537:Peritoneum / Q000293:injuries; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012449:Safety; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D014951:Wounds, Stab / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery
D008751:Methylene Blue