Analysis of laparoscopy in trauma

Background: The optimum roles for laparoscopy in trauma have yet to be esta blished. To date, reviews of laparoscopy in trauma have been primarily desc riptive rather than analytic. This article analyzes the results of laparosc opy in trauma. Study Design: Outcome analysis was done by reviewing 37 studies with more t han 1,900 trauma patients, and laparoscopy was analyzed as a screening, dia gnostic, or therapeutic tool. Laparoscopy was regarded as a screening tool if it was used to detect or exclude a positive finding (eg, hemoperitoneum, organ injury, gastrointestinal spillage, peritoneal penetration) that requ ired operative exploration or repair. Laparoscopy was regarded as a diagnos tic tool when it was used to identify all injuries, rather than as a screen ing tool to identify the first indication for a laparotomy. It was regarded as a diagnostic tool only in studies that mandated a laparotomy (gold stan dard) after laparoscopy to confirm the diagnostic accuracy of laparoscopic findings. Costs and charges for using laparoscopy in trauma were analyzed w hen feasible. Results: As a screening tool, laparoscopy missed 1% of injuries and helped prevent 63% of patients from having a trauma laparotomy. When used as a dia gnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient. Overall, laparoscopy carried a 1% procedure-related complication rate. Cost -effectiveness has not been uniformly proved in studies comparing laparosco py and laparotomy. Conclusions: Laparoscopy has been applied safely and effectively as a scree ning tool in stable patients with acute trauma. Because of the large number of missed injuries when used as a diagnostic tool, its value in this conte xt is limited. Laparoscopy has been reported infrequently as a therapeutic tool in selected patients, and its use in this context requires further stu dy. (J Am Cell Surg 1999;189:11-20. (C) 1999 by the American College of Sur geons).