Complementary roles of laparoscopic abdominal exploration and diagnostic peritoneal lavage for evaluating abdominal stab wounds: A prospective study

Purpose: To determine the roles of laparoscopic abdominal exploration (LE) and diagnostic peritoneal lavage (DPL) in the evaluation of abdominal stab wounds, we prospectively compared LE with mandatory celiotomy (MC) in 76 pa tients having anterior abdominal stab wounds penetrating the fascia over a 22-month period. Patients and Methods: Twenty-two patients underwent emergency celiotomy. Th e remaining patients were subjected to DPL and assigned to treatment by eit her celiotomy or initial LE with subsequent conversion to open exploration at the discretion of the attending surgeon. Results: Laparotomy was avoided in 55% of the 31 patients undergoing initia l laparoscopy, and this group demonstrated a significant decrease in the in cidence of nontherapeutic celiotomy, from 19% to 57% (P < 0.05), as well as decreased length of hospital stay (4 +/- 0.6 v 5.9 +/- 0.4 days; P < 0.05) , and total hospital cost ($6119 +/- 756 v $8312 +/- 627; P < 0.05). There were no missed intraabdominal injuries or morbidity from laparoscopy identi fied in follow-up. The DPL (N = 36) was positive in 11 of the 12 patients w ith injury requiring surgical repair and was negative in 16 of the 25 patie nts not requiring repair. The sensitivity and specificity of DPL were 0.91 and 0.64 compared with 1.0 and 0.74 for laparoscopy. Conclusions: An algorithm to evaluate stable patients with anterior abdomin al stab wounds and minimize overall costs of care, incidence of nontherapeu tic celiotomy, and rate of missed injuries is suggested consisting of DPL f ollowed by observation in patients with negative DPL and by laparoscopy in patients with positive DPL. Wounds to the thoracoabdominal region may be be st evaluated by initial LE, as diaphragmatic wounds may result in a false-n egative DPL.