DIAGNOSTIC AND THERAPEUTIC LAPAROSCOPY FOR PENETRATING ABDOMINAL-TRAUMA - A MULTICENTER EXPERIENCE

Background: Considerable skepticism still exists about the role of dia gnostic laparoscopy in the evaluation of penetrating abdominal trauma, The reported experience with therapeutic laparoscopy has been limited , Methods: Retrospective analysis of a collective experience from thre e large urban trauma centers with 510 patients (316 stab wounds, 194 g unshot wounds) who were hemodynamically stable and had no urgent indic ations for celiotomy, Results: Laparotomy was avoided in 277 of the 51 0 patients (54.3%) either because of nonpenetration or insignificant f indings on laparoscopy, All were discharged uneventfully after a mean hospital stay of 1.7 days, Twenty-six had successful therapeutic proce dures on laparoscopy (diaphragmatic repair in 16 patients, cholecystec tomy in 1 patient, hepatic repair in 6 patients, and closure of gastro tomy in 3 patients) with uneventful recovery, In the remaining 203 pat ients, laparotomy was therapeutic in 155, Fifty-two patients had nonth erapeutic celiotomy for exclusion of bowel injuries or as mandatory la parotomy for penetrating gunshot wounds (19.7%), The overall incidence of nontherapeutic laparotomy was 10.2%, Complications from laparoscop y were minimal (10 of 510) and minor, Conclusions: Laparoscopy has an important diagnostic role in stable patients with penetrating abdomina l trauma, In carefully selected patients, therapeutic laparoscopy is p ractical, feasible, and offers all the advantages of minimally invasiv e surgery.