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World Journal of Surgery

Published in:

01-07-2010

Value of Diagnostic and Therapeutic Laparoscopy for Abdominal Stab Wounds

Authors: Heng-Fu Lin, Jiann-Ming Wu, Chao-Chiang Tu, Hsin-An Chen, Hsin-Chin Shih

Published in: World Journal of Surgery | Issue 7/2010

Abstract

Background

The purpose of the present study was to evaluate the use of laparoscopy for the diagnosis and treatment for hemodynamically stable patients with abdominal stab wounds.

Methods

We conducted a retrospective cohort study to compare the outcomes of 86 hemodynamically stable patients with suspected intra-abdominal injuries from abdominal stab wounds who underwent either exploratory laparotomy or diagnostic laparoscopy. Thirty-eight patients (group A) were treated before the adoption of laparoscopy as a diagnostic and therapeutic tool for abdominal stabbing injuries at our hospital, and 48 patients (group B) were treated after. Demographic information, injury severity, operative findings, rates of nontherapeutic interventions, operation time, length of hospital stay, and morbidity of the two groups were evaluated.

Results

There was no difference in the demographics and injury severity between the two groups. Laparoscopy decreased the nontherapeutic laparotomy rate from 57.9% in group A to 0% in group B (P < 0.001). The accuracy of diagnostic laparoscopy was 100% in group B. Patients in group B had a significantly shorter hospital stay (5.0 days versus 9.9 days; P < 0.001) and shorter operation time (90.7 min vs. 118.7 min; P = 0.019) than group A. For patients in group B with significant intra-abdominal injuries, therapeutic laparoscopy was successfully performed in 16 of 17 patients (94.1%), treating a total of 22 intra-abdominal injuries.

Conclusions

Laparoscopy is feasible and safe for the diagnosis and treatment of hemodynamically stable patients with abdominal stab wounds. It can reduce the nontherapeutic laparotomy rate and shorten the length of hospital stay.

Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 205:129–132CrossRefPubMed

Sirinek KR, Page CP, Root HD et al (1990) Is exploratory celiotomy necessary for all patients with truncal stab wounds? Arch Surg 125:844–848PubMed

Leppaniemi A, Salo J, Haapiainen R (1995) Complications of negative laparotomy for truncal stab wounds. J Trauma 38:54–58CrossRefPubMed

Shih HC, Wen YS, Ko TJ et al (1999) Noninvasive evaluation of blunt abdominal trauma: prospective study using diagnostic algorithms to minimize nontherapeutic laparotomy. World J Surg 23:265–270CrossRefPubMed

Murray JA, Demetriades D, Asensio JA et al (1998) Occult injuries to the diaphragm: prospective evaluation of laparoscopy in penetrating injuries to the left lower chest. J Am Coll Surg 187:626–630CrossRefPubMed

Villavicencio RT, Aucar JA (1999) Analysis of laparoscopy in trauma. J Am Coll Surg 189:11–20CrossRefPubMed

Ivatury RR, Simon RJ, Stahl WM (1993) A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 34:822–828CrossRefPubMed

Fabian TC, Croce MA, Stewart RM et al (1993) A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg 217:557–565CrossRefPubMed

Zantut LF, Ivatury RR, Smith RS et al (1997) Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 42:825–831CrossRefPubMed

10.

Sosa JL, Arrillaga A, Puente I et al (1995) Laparoscopy in 121 consecutive patients with abdominal gunshot wounds. J Trauma 39:501–506CrossRefPubMed

11.

Chelly MR, Major K, Spivak J et al (2003) The value of laparoscopy in management of abdominal trauma. Am Surg 69:957–960PubMed

12.

Taner AS, Topgul K, Kucukel F et al (2001) Diagnostic laparoscopy decreases the rate of unnecessary laparotomies and reduces hospital costs in trauma patients. J Laparoendosc Adv Surg Tech A 11:207–211CrossRefPubMed

13.

Smith RS, Fry WR, Morabito DJ et al (1995) Therapeutic laparoscopy in trauma. Am J Surg 170:632–637CrossRefPubMed

14.

Matthews BD, Bui H, Harold KL et al (2003) Laparoscopic repair of traumatic diaphragmatic injuries. Surg Endosc 17:254–258CrossRefPubMed

15.

Chen RJ, Fang JF, Lin BC et al (1998) Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma. J Trauma 44:691–695CrossRefPubMed

16.

Chol YB, Lim KS (2003) Therapeutic laparoscopy for abdominal trauma. Surg Endosc 17:421–427CrossRefPubMed

17.

Mathonnet M, Peyrou P, Gainant A et al (2003) Role of laparoscopy in blunt perforations of the small bowel. Surg Endosc 17:641–645CrossRefPubMed

18.

Kawahara NT, Alster C, Fujimura I et al (2009) Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 67:589–595CrossRefPubMed

19.

Ahmed N, Whelan J, Brownlee J et al (2005) The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg 201:213–216CrossRefPubMed

20.

Marks JM, Youngelman DF, Berk T (1997) Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 11:272–276CrossRefPubMed

21.

Simon RJ, Rabin J, Kuhls D (2002) Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma. J Trauma 53:297–302CrossRefPubMed

22.

Ivatury RR, Simon RJ, Stahl WM (1994) Selective celiotomy for missile wounds of the abdomen based on laparoscopy. Surg Endosc 8:366–370CrossRefPubMed

23.

Hallfeldt KK, Trupka AW, Erhard J et al (1998) Emergency laparoscopy for abdominal stab wounds. Surg Endosc 12:907–910CrossRefPubMed

24.

DeMaria EJ, Dalton JM, Gore DC et al (2000) Complementary roles of laparoscopic abdominal exploration and diagnostic peritoneal lavage for evaluating abdominal stab wounds: a prospective study. J Laparoendosc Adv Surg Tech A 10:131–136CrossRefPubMed

25.

Leppaniemi A, Haapiainen R (2003) Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study. J Trauma 55:636–645CrossRefPubMed

26.

Sosa JL, Baker M, Puente I et al (1995) Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy. J Trauma 38:194–197CrossRefPubMed

27.

Rossi P, Mullins D, Thal E (1993) Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg 166:707–711CrossRefPubMed

28.

Gorecki PJ, Cottam D, Angus LD et al (2002) Diagnostic and therapeutic laparoscopy for trauma: a technique of safe and systematic exploration. Surg Laparosc Endosc Percutan Tech 12:195–198CrossRefPubMed

29.

Livingston DH, Tortella BJ, Blackwood J et al (1992) The role of laparoscopy in abdominal trauma. J Trauma 33:471–475CrossRefPubMed

30.

Cherkasov M, Sitnikov V, Sarkisyan B et al (2008) Laparoscopy versus laparotomy in management of abdominal trauma. Surg Endosc 22:228–231CrossRefPubMed

31.

Josephs LG, Este-McDonald JR, Birkett DH et al (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–819CrossRefPubMed

Title: Value of Diagnostic and Therapeutic Laparoscopy for Abdominal Stab Wounds
Authors: Heng-Fu Lin
Jiann-Ming Wu
Chao-Chiang Tu
Hsin-An Chen
Hsin-Chin Shih
Publication date: 01-07-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 7/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0485-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Value of Diagnostic and Therapeutic Laparoscopy for Abdominal Stab Wounds

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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