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Diagnostic laparoscopy in penetrating abdominal trauma
Annelise Maree Cocco1, Savitha Bhagvan2, Clare Bouffler1
1Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
ANZ Journal of Surgery
|March 16, 2019
Summary
Diagnostic laparoscopy is a safe method for evaluating anterior abdominal stab wounds. However, it can lead to a high rate of non-therapeutic laparotomies, necessitating strategies to reduce unnecessary surgeries.
Area of Science:
- Trauma Surgery
- Surgical Diagnostics
- Emergency Medicine
Background:
- Penetrating abdominal trauma is rare in Australia.
- Management of patients without immediate laparotomy indication requires careful consideration.
- This study focuses on anterior abdominal stab wounds in a Level 1 trauma center.
Purpose of the Study:
- To examine the management of penetrating anterior abdominal injuries.
- To investigate the outcomes of patients undergoing diagnostic laparoscopy.
- To evaluate the effectiveness and safety of diagnostic laparoscopy in trauma care.
Main Methods:
- Retrospective review of 318 patients with anterior abdominal stab wounds over 15 years.
- Data extraction included demographics, injury details, examination findings, treatments, and outcomes.
- Analysis performed using SPSS PASW version 20.
Main Results:
- 146 patients underwent diagnostic laparoscopy out of 197 not requiring immediate laparotomy.
- Diagnostic laparoscopy had 100% sensitivity and 100% negative predictive value for peritoneal breach.
- 45.6% of exploratory laparotomies following laparoscopy were therapeutic; non-therapeutic laparotomies had a 9.3% complication rate.
Conclusions:
- Diagnostic laparoscopy is a safe approach for anterior abdominal stab wounds.
- Using peritoneal breach as an indication for laparotomy results in a moderate rate of non-therapeutic procedures.
- Strategies to reduce non-therapeutic laparotomy rates are recommended.
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