Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 May;217(5):557–565. doi: 10.1097/00000658-199305010-00017

A prospective analysis of diagnostic laparoscopy in trauma.

T C Fabian 1, M A Croce 1, R M Stewart 1, F E Pritchard 1, G Minard 1, K A Kudsk 1
PMCID: PMC1242845  PMID: 8489319

Abstract

OBJECTIVE: This study was performed to assess current and potential future application for laparoscopy (DL) in the diagnosis of penetrating and blunt injuries. Efficacy, safety, and cost analyses were performed. SUMMARY BACKGROUND DATA: Diagnostic peritoneal lavage (DPL) and computed tomography (CT) have been the mainstays in recent years for diagnosis of equivocal nontherapeutic laparotomy, whereas CT is not helpful for the vast majority of penetrating wounds. DL may be a useful adjunct to fill in these gaps. METHODS: Hemodynamically stable patients with equivocal evidence of intraabdominal injury were prospectively entered into the protocol. DL was performed under general anesthesia; patients with wounds penetrating the peritoneum or blunt injury with significant organ injury underwent laparotomy. RESULTS: Over 19 months, 182 patients (55% stab, 36% GSW, 9% blunt) were studied. No peritoneal penetration was found at DL in 55% of penetrating wounds with 66% of the remainder having therapeutic laparotomy, 17% nontherapeutic laparotomy, and 17% negative laparotomy. Therapeutic laparotomy was performed in 53% of blunt injuries after DL. Tension pneumothorax occurred in one patient and one had an iatrogenic small bowel injury. Charges for DL were $3,325 per patient compared with $3,320 for a similar group undergoing negative laparotomy before this protocol. CONCLUSIONS: DL is a safe modality for trauma. With current technology, DL is most efficacious for evaluation of equivocal penetrating wounds. Significant cost savings would be gained by performance under local anesthesia. Development of miniaturized optics, bowel clamps, retractors, and stapling devices will reduce overall costs and permit some therapeutic applications for laparoscopy in trauma management.

Full text

PDF
557

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beckman I., Dash N., Sefczek R. J., Lupetin A. R., Anderson J. S., Diamond D. L., Young J. C. Ultrasonographic findings in acute acalculous cholecystitis. Gastrointest Radiol. 1985;10(4):387–389. doi: 10.1007/BF01893137. [DOI] [PubMed] [Google Scholar]
  2. Berci G., Sackier J. M., Paz-Partlow M. Emergency laparoscopy. Am J Surg. 1991 Mar;161(3):332–335. doi: 10.1016/0002-9610(91)90590-a. [DOI] [PubMed] [Google Scholar]
  3. Carnevale N., Baron N., Delany H. M. Peritoneoscopy as an aid in the diagnosis of abdominal trauma: a preliminary report. J Trauma. 1977 Aug;17(8):634–641. doi: 10.1097/00005373-197708000-00011. [DOI] [PubMed] [Google Scholar]
  4. Cogbill T. H., Moore E. E., Jurkovich G. J., Morris J. A., Mucha P., Jr, Shackford S. R., Stolee R. T., Moore F. A., Pilcher S., LoCicero R. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma. 1989 Oct;29(10):1312–1317. doi: 10.1097/00005373-198910000-00002. [DOI] [PubMed] [Google Scholar]
  5. Croce M. A., Fabian T. C., Kudsk K. A., Baum S. L., Payne L. W., Mangiante E. C., Britt L. G. AAST organ injury scale: correlation of CT-graded liver injuries and operative findings. J Trauma. 1991 Jun;31(6):806–812. [PubMed] [Google Scholar]
  6. Feliciano D. V. Diagnostic modalities in abdominal trauma. Peritoneal lavage, ultrasonography, computed tomography scanning, and arteriography. Surg Clin North Am. 1991 Apr;71(2):241–256. doi: 10.1016/s0039-6109(16)45377-6. [DOI] [PubMed] [Google Scholar]
  7. Gazzaniga A. B., Stanton W. W., Bartlett R. H. Laparoscopy in the diagnosis of blunt and penetrating injuries to the abdomen. Am J Surg. 1976 Mar;131(3):315–318. doi: 10.1016/0002-9610(76)90124-0. [DOI] [PubMed] [Google Scholar]
  8. Knudson M. M., Lim R. C., Jr, Oakes D. D., Jeffrey R. B., Jr Nonoperative management of blunt liver injuries in adults: the need for continued surveillance. J Trauma. 1990 Dec;30(12):1494–1500. doi: 10.1097/00005373-199012000-00009. [DOI] [PubMed] [Google Scholar]
  9. Malangoni M. A., Cué J. I., Fallat M. E., Willing S. J., Richardson J. D. Evaluation of splenic injury by computed tomography and its impact on treatment. Ann Surg. 1990 May;211(5):592–599. doi: 10.1097/00000658-199005000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Matsubara T. K., Fong H. M., Burns C. M. Computed tomography of abdomen (CTA) in management of blunt abdominal trauma. J Trauma. 1990 Apr;30(4):410–414. [PubMed] [Google Scholar]
  11. Merlotti G. J., Marcet E., Sheaff C. M., Dunn R., Barrett J. A. Use of peritoneal lavage to evaluate abdominal penetration. J Trauma. 1985 Mar;25(3):228–231. doi: 10.1097/00005373-198503000-00011. [DOI] [PubMed] [Google Scholar]
  12. Moore E. E., Moore J. B., Van Duzer-Moore S., Thompson J. S. Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg. 1980 Dec;140(6):847–851. doi: 10.1016/0002-9610(80)90130-0. [DOI] [PubMed] [Google Scholar]
  13. Pachter H. L., Spencer F. C., Hofstetter S. R., Liang H. G., Coppa G. F. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992 May;215(5):492–502. doi: 10.1097/00000658-199205000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. ROOT H. D., HAUSER C. W., MCKINLEY C. R., LAFAVE J. W., MENDIOLA R. P., Jr DIAGNOSTIC PERITONEAL LAVAGE. Surgery. 1965 May;57:633–637. [PubMed] [Google Scholar]
  15. Robin A. P., Andrews J. R., Lange D. A., Roberts R. R., Moskal M., Barrett J. A. Selective management of anterior abdominal stab wounds. J Trauma. 1989 Dec;29(12):1684–1689. doi: 10.1097/00005373-198912000-00018. [DOI] [PubMed] [Google Scholar]
  16. Sherwood R., Berci G., Austin E., Morgenstern L. Minilaparoscopy for blunt abdominal trauma. Arch Surg. 1980 May;115(5):672–673. doi: 10.1001/archsurg.1980.01380050092023. [DOI] [PubMed] [Google Scholar]
  17. Shuman W. P., Rogers J. V., Rudd T. G., Mack L. A., Plumley T., Larson E. B. Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis. AJR Am J Roentgenol. 1984 Mar;142(3):531–534. doi: 10.2214/ajr.142.3.531. [DOI] [PubMed] [Google Scholar]
  18. Sosa J. L., Sims D., Martin L., Zeppa R. Laparoscopic evaluation of tangential abdominal gunshot wounds. Arch Surg. 1992 Jan;127(1):109–110. doi: 10.1001/archsurg.1992.01420010131021. [DOI] [PubMed] [Google Scholar]
  19. Trooskin S. Z., Boyarsky A. H., Greco R. S. Peritoneal lavage in patients with normal mentation and hematuria after blunt trauma. Surg Gynecol Obstet. 1985 Feb;160(2):145–147. [PubMed] [Google Scholar]
  20. Weissmann H. S., Berkowitz D., Fox M. S., Gliedman M. L., Rosenblatt R., Sugarman L. A., Freeman L. M. The role of technetium-99m iminodiacetic acid (IDA) cholescintigraphy in acute acalculous cholecystitis. Radiology. 1983 Jan;146(1):177–180. doi: 10.1148/radiology.146.1.6681568. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES