LAPAROSCOPY IN 121 CONSECUTIVE PATIENTS WITH ABDOMINAL GUNSHOT WOUNDS

Objective: The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of diagnostic laparoscopy (DL) in:a large group of stable patients with abdominal gunshot wounds (ABGSWs). Design: This study was a prospective case series developed by managem ent protocol. Materials and Methods: In a 21/2-year period, DL was per formed in 121 consecutive patients who were hemodynamically stable wit h ABGSWs and met protocol criteria. This represented 18% of all patien ts with ABGSWs seen in this period at the Ryder Trauma Center. The eva luation was conducted to determine peritoneal violation, the presence of intra-abdominal blood, and the need for exploration. Measurements a nd Main Results: There were 42 (35%) positive and 79 (65%) negative DL s. In patients with positive DL, 39 (92.8%) had exploratory laparotomy . In this group, 32 (82%) had therapeutic laparotomy, 6 (15.4%) had no ntherapeutic laparotomy, and 1 (2.5%): had a negative laparotomy. In t his patient, DL was felt to be inadequate by the attending surgeon, al though no penetration or intraperitoneal blood were present, and a neg ative laparotomy was done. This represents a failure rate of 0.8%. The re were 3 (7.2%); positive DLs, in whom laparotomy was not performed. These patients. had isolated nonbleeding liver injuries; and nontherap eutic laparotomy was successfully avoided, The negative DL group was d ivided into 47 patients (60%) with isolated ABGSWs, and 32 patients (4 0%) with associated injuries; mostly orthopedic and thoracic; There we re no false-negative DLs and no delayed laparotomies in these 121 pati ents. There was no mortality in this study group. The sensitivity for peritoneal penetration was 100%; and the specificity was 98.7%. The po sitive predictive value was 97.6%, and the negative predictive value w as 100%; In deciding on need for laparotomy (i.e., injury requiring re pair), DL had a positive predictive value of 82%; more importantly, th e negative predictive value was 100%. Conclusions: In stable patients with ABGSWs and questionable intra-abdominal injury; DL can be safely used. It is highly sensitive and specific. It can effectively reduce t he incidence of negative and nontherapeutic laparotomies; and the over all morbidity and hospital stay in this group of patients.