Complementary roles of laparoscopic abdominal exploration and diagnostic peritoneal lavage for evaluating abdominal stab wounds

A prospective study

Eric J. DeMaria, Joseph M. Dalton, Dennis Gore, John M. Kellum, Harvey J. Sugerman

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose: To determine the roles of laparoscopic abdominal exploration (LE) and diagnostic peritoneal lavage (DPL) in the evaluation of abdominal stab wounds, we prospectively compared LE with mandatory celiotomy (MC) in 76 patients having anterior abdominal stab wounds penetrating the fascia over a 22-month period. Patients and Methods: Twenty-two patients underwent emergency celiotomy. The remaining patients were subjected to DPL and assigned to treatment by either celiotomy or initial LE with subsequent conversion to open exploration at the discretion of the attending surgeon. Results: Laparotomy was avoided in 55% of the 31 patients undergoing initial laparoscopy, and this group demonstrated a significant decrease in the incidence of nontherapeutic celiotomy, from 19% to 57% (P < 0.05), as well as decreased length of hospital stay (4 ± 0.6 v 5.9 ± 0.4 days; P < 0.05), and total hospital cost ($6119 ± 756 v $8312 ± 627; P < 0.05). There were no missed intra-abdominal injuries or morbidity from laparoscopy identified in follow-up. The DPL (N = 36) was positive in 11 of the 12 patients with injury requiring surgical repair and was negative in 16 of the 25 patients not requiring repair. The sensitivity and specificity of DPL were 0.91 and 0.64 compared with 1.0 and 0.74 for laparoscopy. Conclusions: An algorithm to evaluate stable patients with anterior abdominal stab wounds and minimize overall costs of care, incidence of nontherapeutic celiotomy, and rate of missed injuries is suggested consisting of DPL followed by observation in patients with negative DPL and by laparoscopy in patients with positive DPL. Wounds to the thoracoabdominal region may be best evaluated by initial LE, as diaphragmatic wounds may result in a false-negative DPL.

Original languageEnglish (US)
Pages (from-to)131-136
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques - Part A
Volume10
Issue number3
StatePublished - Jun 2000
Externally publishedYes

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Stab Wounds
Peritoneal Lavage
Prospective Studies
Laparoscopy
Length of Stay
Wounds and Injuries
Abdominal Injuries
Hospital Costs
Fascia
Incidence
Intraoperative Complications
Laparotomy
Emergencies
Observation

ASJC Scopus subject areas

  • Surgery

Cite this

Complementary roles of laparoscopic abdominal exploration and diagnostic peritoneal lavage for evaluating abdominal stab wounds : A prospective study. / DeMaria, Eric J.; Dalton, Joseph M.; Gore, Dennis; Kellum, John M.; Sugerman, Harvey J.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A, Vol. 10, No. 3, 06.2000, p. 131-136.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the roles of laparoscopic abdominal exploration (LE) and diagnostic peritoneal lavage (DPL) in the evaluation of abdominal stab wounds, we prospectively compared LE with mandatory celiotomy (MC) in 76 patients having anterior abdominal stab wounds penetrating the fascia over a 22-month period. Patients and Methods: Twenty-two patients underwent emergency celiotomy. The remaining patients were subjected to DPL and assigned to treatment by either celiotomy or initial LE with subsequent conversion to open exploration at the discretion of the attending surgeon. Results: Laparotomy was avoided in 55{\%} of the 31 patients undergoing initial laparoscopy, and this group demonstrated a significant decrease in the incidence of nontherapeutic celiotomy, from 19{\%} to 57{\%} (P < 0.05), as well as decreased length of hospital stay (4 ± 0.6 v 5.9 ± 0.4 days; P < 0.05), and total hospital cost ($6119 ± 756 v $8312 ± 627; P < 0.05). There were no missed intra-abdominal injuries or morbidity from laparoscopy identified in follow-up. The DPL (N = 36) was positive in 11 of the 12 patients with injury requiring surgical repair and was negative in 16 of the 25 patients not requiring repair. The sensitivity and specificity of DPL were 0.91 and 0.64 compared with 1.0 and 0.74 for laparoscopy. Conclusions: An algorithm to evaluate stable patients with anterior abdominal stab wounds and minimize overall costs of care, incidence of nontherapeutic celiotomy, and rate of missed injuries is suggested consisting of DPL followed by observation in patients with negative DPL and by laparoscopy in patients with positive DPL. Wounds to the thoracoabdominal region may be best evaluated by initial LE, as diaphragmatic wounds may result in a false-negative DPL.",
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