THE ROLE OF LAPAROSCOPY IN BLUNT ABDOMINAL-TRAUMA

In a collective analysis of 11 reports with a total of 355 blunt abdom inal trauma patients, the sensitivity and specificity of diagnostic la paroscopy in predicting the eventual need for therapeutic laparotomy w ere 94% and 98%, respectively, with an overall accuracy of 97%, Althou gh fairly accurate and safe (morbidity rate about 1.2%), the invasiven ess, cost and time-consuming nature of diagnostic laparoscopy limit it s routine use in trauma patients, It could, however, be useful in sele cting patients with minor or nonbleeding injuries for nonoperative man agement after positive peritoneal lavage or computed tomography, and i n excluding occult bowel and diaphragmatic injuries in patients with e quivocal findings, thereby reducing the number of unnecessary laparoto mies, With the improvement of laparoscopic techniques and instrumentat ion, more injuries can probably be managed laparoscopically with all t he benefits observed with the shift from open to laparoscopic procedur es in other patient populations, and it is likely that laparoscopy wil l find its place as an integral part of evaluating and treating patien ts with blunt abdominal trauma, At present, however, laparoscopy canno t be recommended as a routine tool for evaluating patients with blunt abdominal trauma, except in controlled clinical trials.