THE ROLE OF DIAGNOSTIC LAPAROSCOPY IN THE MANAGEMENT OF TRAUMA PATIENTS - A PRELIMINARY ASSESSMENT

This study evaluated the role and advantages of diagnostic laparoscopy (DL) compared with diagnostic peritoneal lavage (DPL) in 75 trauma pa tients who were prospectively studied with DL followed by DPL. Of thes e, 59 patients had blunt injuries and 16 stab wounds. Seventy patients (93%) had the procedures performed in the emergency department (ED); 41 (59%) of these were awake and under local anethesia. Forty-two pati ents had negative DPL and DL results with no subsequent sequelae. Twen ty-three patients had negative DPL results and abnormal DL results. Of these, 20 were managed nonsurgically, and three (DPL < 10,000 RBC) un derwent surgery based solely on DL findings of diaphragmatic laceratio ns from stab wounds. These were repaired. All 23 had an uneventful cou rse. Three patients had positive DPL and insignificant DL findings. La parotomy and DL findings correlated. A splenectomy for iatrogenic inju ry unrelated to DL and two nontherapeutic laparotomies were performed. Seven patients demonstrated both positive DPL and significant DL find ings, and all had therapeutic laparotomies. Management based on DL rat her than DPL would potentially have improved care in 8% of cases (6 of 75). Reliance on DL improved care in 19% (3 of 16) of patients with s tab wounds and possibly could have in 3% (2 of 59) of those with blunt injuries. Management using DL would have potentially improved care in 30% (3 of 10) of patients with positive DPL findings and 5% (3 of 65) with negative DPL findings. Diagnostic laparoscopy can be performed s afely in stable patients under local anesthesia in the ED. It offers n o advantage over DPL as a primary assessment tool in blunt trauma. It does have advantages in the management of stab wounds. Diagnostic lapa roscopy has a role in redefining DPL criteria for laparotomy and, in s elected patients, as an adjunct to DPL, allowing further diagnosis and potentially the treatment of injuries without laparotomy.