The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds

• Published in: The American journal of surgery Vol. 196; no. 6; pp. 871 - 877
• Main Authors: Kopelman, Tammy R., M.D., F.A.C.S, O'Neill, Patrick J., Ph.D., M.D., F.A.C.S, Macias, Luis H., M.D, Cox, Jordy C., M.D., F.A.C.S, Matthews, Marc R., M.D., F.A.C.S, Drachman, David A., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2008; Elsevier Limited
• Subjects: Abdomen; Abdominal Injuries - diagnosis; Abdominal Injuries - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Anterior abdominal stab wounds; Computed tomography; Demographics; Diagnostic laparoscopy; Diagnostic peritoneal lavage; Female; Follow-Up Studies; Heart attacks; Hospital charges; Humans; Injuries; Laparoscopy - utilization; Laparotomy; Laparotomy - methods; Length of stay; Local wound exploration; Male; Middle Aged; Mortality; Nontherapeutic; Prognosis; Reproducibility of Results; Respiratory distress syndrome; Retrospective Studies; Serial abdominal examinations; Surgery; Therapeutic; Trauma Severity Indices; Wounds, Stab - diagnosis; Wounds, Stab - surgery; Young Adult; Diagnostic laparoscopy; Computed tomography; Diagnostic peritoneal lavage; Nontherapeutic; Hospital charges; Local wound exploration; Serial abdominal examinations; Therapeutic; Anterior abdominal stab wounds; Laparotomy; Length of stay
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2008.07.031

Abstract Background To assess if diagnostic laparoscopy (DL) is superior to nonoperative modes (serial abdominal examination with/without computed axial tomography [CAT] and diagnostic peritoneal lavage) in determining the need for therapeutic laparotomy (TL) after anterior abdominal stab wound (ASW). Methods Retrospective review of ASW patients. Patients were divided into group A (DL/exploratory laparotomy) to identify peritoneal violation (PV) and group B (initial nonoperative modes). Results Seventy-three patients met inclusion criteria. In group A (n = 38), 29 patients (76%) had PV by DL and underwent exploratory laparotomy. Only 10 (35%) underwent TL (sensitivity for PV = 100%; specificity and positive predictive value of PV in determining need for TL = 29% and 33%, respectively). In group B (n = 35), 7 patients (20%) underwent TL, yielding an improved specificity (96%) and positive predictive value (88%). Conclusions We find no role for DL in the evaluation of ASW patients solely to determine PV.