[Laparoscopic management of abdominal wounds]

The management of abdominal wounds apart from an extreme emergency remains controversed. Means vary between explorative laparotomy and mere monitoring. Between these two extreme cases, laparoscopy as an exploration means plays a significant role, by avoiding laparotomy and by establishing the early diagnosis of lesions.

The objective of this study is to report our experience in laparoscopic management of frontal abdominal wounds caused by a blank arm.

Between January 2004 and December 2008, 61 patients with 27-year average age showing anterior abdominal wounds caused by a blank arm, with stable hemodynamic status have been subjected to a laparoscopic exploration.

Laparoscopic exploration revealed a penetrating wound in 36 patients (59% of cases) of whom 27 had perforating wound. Six patients had a frontal abdominal wound, of which four have required a thoracic drainage in addition to the laparoscopic exploration of abdominal cavities. Two patients had a left diaphragmatic wound. Twelve patients (19.7%) have required a therapeutic action that consisted in an electro coagulation of filled organs, a simple suture or a resection-anastomosis for the digestive tract, and suture of diaphragmatic wounds. A conversion was performed in 7 patients (11.5%). The death rate was nul. Morbidity rate was 3.2%. Average hospitalization course was 2.54 days.

Laparoscopy is a safe and efficient means for exploration of abdominal cavity in patients showing a frontal abdominal wound. It allows avoiding a systematic or useless laparotomy in 88.5% of wounded individuals and then allows to trait some lesions without recours to laparotomy.