Penetrating abdominal wounds are traditionally explored by laparotomy.
Dr Naveed Ahmed and colleagues from Cleveland investigated prospectively the role of laparoscopy.
The research team conducted the study within a defined protocol for management of penetrating abdominal wounds.
The team determined its safety and advantages over traditional operative management.
The researchers analyzed various factors including stab and gun shot abdominal wounds, junction zone injuries, and stable vital signs.
The researchers also assessed the absence of contraindications for laparoscopy.
|29% had no visceral injuries despite violation of peritoneum or diaphragm|
|Journal of the American College of Surgeons|
The diagnostic end points included detection of peritoneum or diaphragm violation, visceral injuries, and other indications for laparotomy.
The researchers undertook a systematic examination using a multiport technique whenever the peritoneum or diaphragm had been violated.
The team conducted all repairs by open operation.
The researchers found that 41% of patients with penetrating trauma fulfilled study criteria.
Of the patients fulfilling the criteria, 33% had no peritoneal penetration, and 29% had no visceral injuries despite violation of peritoneum or diaphragm.
The team observed that 38% of the patients fulfilling the criteria had visceral injuries, of which 40% required no intervention.
The research team noted that 23% had open repairs and that no missed injuries or death occurred in the study.
Overall, 77% of penetrating injuries with stable vital signs avoided exploratory laparotomy.
The researchers compared the results with the National Trauma Data Bank information for patients with the same Injury Severity Scores.
The team found that hospitalization was reduced by more than 55% for the entire series.
Dr Ahmed's team concludes, “Laparoscopy for penetrating abdominal injuries in a defined set of conditions was safe and accurate, effectively eliminating nontherapeutic laparotomy and shortening hospitalization.”