NEGATIVE LAPAROTOMY IN ABDOMINAL GUNSHOT WOUNDS - POTENTIAL IMPACT OFLAPAROSCOPY

Objective: To evaluate the morbidity and hospital stay resultant from negative exploratory laparotomy (NL) for abdominal gunshot wounds (ABG SWs) and the potential impact the use of diagnostic laparoscopy (DL) c ould have on these variables. Design: A retrospective study was conduc ted. Materials and Methods: The charts of all patients with ABGSWs ove r a 4-year period were reviewed. Data was collected on injuries, rate of NL, morbidity and hospital stay. This was compared to a subsequent group of patients with ABGSWs managed with a DL protocol. Measurements and Main Results: Over a 4-year period, 817 patients had exploratory laparotomy (EL) for ABGSWs. The NL rate was 12.4% (101 of 817); 69 of these patients had no associated injury or other procedures. They had a 22% morbidity and an average hospital stay of 5.1 days. Subsequently , 85 patients with ABGSWs underwent DL, This group was similar to the EL group and would have undergone EL prior to the introduction of DL a t our institution. In this group, 34 patients had no associated injury or other procedures. They had a 3% morbidity, and their average hospi tal stay was 1.4 days. The morbidity and hospital stay were statistica lly significantly reduced (p < 0.01) in patients with negative DL vers us NL. Conclusions: These data demonstrate that NL is associated with a high morbidity and long hospital stay. The use of DL can reduce the rate of NL, and result in lower morbidity and shorter hospital stay in patients with ABGSWs.