Laparoscopy in the Evaluation of Abdominal Stab Wounds

Abstract

A retrospective study was designed to compare the accuracy and potential advantages of laparoscopy vs. laparotomy in the management of abdominal stab wounds. Thirty-five patients with abdominal stab wounds and scheduled for abdominal surgical exploration based on clinical evaluation were included. Hemodynamically unstable patients were excluded from the evaluation, laparotomy being performed immediately. Laparotomy was performed in 18 and laparoscopy in 17 patients. Penetrating wounds were observed in 65% of the patients (66.6% for laparotomy and 64.7% for laparoscopy). The diagnostic accuracy of laparoscopy was 100%, and laparotomy 89%. Four patients operated on by laparoscopy were converted to laparotomy (22%): in 2 patients to ascertain the origin of hemorrhage, and in 2 patients to suture a bowel laceration. No mortality was noted. Morbidity was observed in 4 patients managed by laparotomy: delirium tremens; pulmonary infection; missed small bowel injury, and stress bleeding ulcus. The postoperative hospital stay was significantly shorter for the patients explored by laparoscopy than for those explored by laparotomy (5.6 vs. 10.2 days, p = 0.02). We conclude that laparoscopy is a safe and accurate method for the evaluation of abdominal stab wounds. It avoids unnecessary laparotomy in 78% of cases. It led to less morbidity and shorter hospital stay than laparotomy. Further evaluation is required to determine the potential to treat major acute lesions by laparoscopy.