LAPAROSCOPY FOR TRIAGE OF PENETRATING TRAUMA - THE DECISION TO EXPLORE

The role of diagnostic laparoscopy in penetrating trauma continues to evolve. We reviewed our experience to determine the effect of laparosc opy on therapeutic laparotomy rates, length of hospital stay, and hosp ital charges. Laparoscopy was performed on 106 hemodynamically stable patients with penetrating abdominal injuries (66 had gunshot wounds, 4 0 had stab wounds). All patients with laparoscopically identified peri toneal penetration underwent open laparotomy. At laparoscopy, 41 (39%) had positive findings, whereas 65 (61%) had none. Two patients with r etroperitoneal hematomas and one with ecchymosis of the peritoneum wer e not explored. Thus 68 (64%) did not require laparotomy. Among the 38 who underwent laparotomy, 29 (76%) had positive findings and 9 (24%) had a negative laparotomy. Nineteen patients (50%) had a therapeutic l aparotomy. This compares with a therapeutic laparotomy rate of 18% had all 106 patients undergone mandatory laparotomy. Data for length of s tay and hospital charges were analyzed. Due to the extended stay assoc iated with tube thoracostomy (n = 21), a subgroup excluding patients w ith chest tubes was also analyzed. In this subgroup, there was a signi ficant difference in hospital stay between those who had only a laparo scopy and those who underwent a negative laparotomy (2.6 +/- 1.7 vs. 4 .7 +/- 1.6, p < 0.01). The average nonsurgical charge for patients who had a negative laparotomy was more than double that for those who had laparoscopy only ($8275 +/- 4692 vs. $3762 +/- 3786, p < 0.01). We co nclude that the use of diagnostic laparoscopy to identify peritoneal p enetration resulted in an improved therapeutic laparotomy rate as well as significant reduction in hospital stay and hospital charges.