THERAPEUTIC LAPAROSCOPY IN TRAUMA

PURPOSE: To assess the therapeutic potential of emergent laparoscopy i n the trauma setting, a retrospective review was performed in a busy u rban trauma center. PATIENTS AND METHODS: Between December 1991 and Oc tober 1993, 133 hemodynamically stable patients with suspected abdomin al injury were evaluated laparoscopically. All laparoscopic procedures were performed in the operating room under general anesthesia, Mechan ism of injury was stab wound (58), gunshot wound (57), and blunt traum a (18), No significant injuries were found in 72 patients (54%), and t hese patients received no further treatment. On the basis of laparosco pic findings, 52 patients underwent formal exploratory laparotomy. Sur gical exploration confirmed the presence of significant injuries in 44 of the 52 patients (85%), Therapeutic laparoscopy was performed in 6 patients (5%) for diaphragm repair (4), gastrotomy repair (1), and spl enorrhaphy (1). Additionally, 10 patients underwent laparoscopy-guided blood salvage for autotransfusion during laparoscopic evaluation of b lunt trauma, Three small-bowel enterotomies were repaired during minil aparotomy. RESULTS: NO significant injuries were missed as a result of our use of laparoscopy in trauma assessment, Complications-trocar ent erotomy, trocar laceration of the inferior epigastric artery, and tran sient hypotension-occurred in 3 patients secondary to the use of lapar oscopy. CONCLUSIONS: Trauma laparoscopy is a safe method for the evalu ation of selected patients with abdominal trauma and can reduce the nu mber of negative and nontherapeutic trauma laparotomies performed. Lim ited therapeutic intervention is possible in a small number of patient s.