[The value of laparoscopy in diagnosis and therapy of the traumatized abdomen]

The prognosis of abdominal trauma depends in most cases not only on the extent of existing injuries but also on prompt therapy. Thus, diagnostic measures have to clarify rapidly and accurately whether laparotomy has to be performed or not. Difficulties in decision for the surgeon arise especially in cases of abdominal trauma where diagnostic imaging (ultrasonography, CT scan) does not lead to clearcut results. From 1st June, 91 to 30th November, 93 we performed diagnostic laparoscopy in 18 cases of abdominal trauma. In 4 patients no injuries were discovered and 5 patients had negligible injuries so that no therapy was necessary. In 4 cases the detected injuries were managed laparoscopically, whilst the remaining 5 patients had to be laparotomied. Of the 11 patients who would normally have been laparotomied as a primary measure, laparotomy was avoided in 5 cases by performing a laparoscopy (45%). On the other hand, we detected injuries on laparoscopy in 3 of the 7 patients who would not have been laparotomied on the basis of the results of the prelaparoscopic investigations. In 2 of these patients the additional injuries would have led to later complications, which were avoided by timely laparotomy following laparoscopic diagnosis. In our opinion laparoscopy is not a substitute for proven diagnostic measures such as ultrasonography or CT scan. However, it is valuable extension of diagnostic and therapeutic methods on abdominal trauma.