A PROSPECTIVE ANALYSIS OF DIAGNOSTIC LAPAROSCOPY IN TRAUMA

Objective This study was performed to assess current and potential fut ure application for laparoscopy (DL) in the diagnosis of penetrating a nd blunt injuries. Efficacy, safety, and cost analyses were performed. Summary Background Data Diagnostic peritoneal lavage (DPL) and comput ed tomography (CT) have been the mainstays in recent years for diagnos is of equivocal nontherapeutic laparotomy, whereas CT is not helpful f or the vast majority of penetrating wounds. DL may be a useful adjunct to fill in these gaps. Methods Hemodynamically stable patients with e quivocal evidence of intraabdominal injury were prospectively entered into the protocol. DL was performed under general anesthesia; patients with wounds penetrating the peritoneum or blunt injury with significa nt organ injury underwent laparotomy. Results Over 19 months, 182 pati ents (55% stab, 36% GSW, 9% blunt) were studied. No peritoneal penetra tion was found at DL in 55% of penetrating wounds with 66% of the rema inder having therapeutic laparotomy, 17% nontherapeutic laparotomy, an d 17% negative laparotomy. Therapeutic laparotomy was performed in 53% of blunt injuries after DL. Tension pneumothorax occurred in one pati ent and one had an iatrogenic small bowel injury. Charges for DL were $3,325 per patient compared with $3,320 for a similar group undergoing negative laparotomy before this protocol. Conclusions DL is a safe mo dality for trauma. With current technology, DL is most efficacious for evaluation of equivocal penetrating wounds. Significant cost savings would be gained by performance under local anesthesia. Development of miniaturized optics, bowel clamps, retractors, and stapling devices wi ll reduce overall costs and permit some therapeutic applications for l aparoscopy in trauma management.