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Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region
A Mahajna1, S Mitkal, H Bahuth
1Department of Surgery A, and the Bruce Rappaport Faculty of Medicine, Rambam Medical Center, Technion-Israel Institute of Technology, POB 9602, Haifa 31096, Israel.
Background:
The role of laparoscopy in diagnosis of penetrating abdominal injuries is still controversial. In the present investigation diagnostic laparoscopy was studied in penetrating injuries of the thoracoabdominal region.
Methods:
Between March 1998 and June 2003, 43 patients with penetrating thoracoabdominal injuries underwent diagnostic laparoscopy at the Rambam Medical Center. There were 41 males and two females; the average age was 30 years (range, 16-54 years). Thirty-one patients had a lower chest injury, eight patients had an upper abdomen and flank injury, and four patients had combined chest and abdomen injuries. In 11 patients intraperitoneal penetration was diagnosed. In 10 patients the procedure was converted to open laparotomy, and one patient with a small laceration of the right diaphragm opposite the liver was observed without laparotomy.
Results:
The average operating time for the laparoscopy was 25 min (10-45 min), and 85 min (40-175 min) for laparotomy. Patients who underwent laparoscopy were discharged after an average of 1.6 (1-3) days, while those who underwent laparotomy were discharged after an average of 7.6 (2-15) days.
Conclusions:
Laparoscopy is a useful diagnostic tool in penetrating injuries of the chest, thoracoabdominal region, and flank. This procedure is particularly reliable in diaphragmatic tears. Laparoscopy should be considered the procedure of choice for the evaluation of penetrating injuries of the lower chest and upper abdomen for diagnosis of peritoneal penetration.
