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Minimally invasive is maximally effective: Diagnostic and therapeutic laparoscopy for penetrating abdominal injuries

Chestovich, Paul J. MD; Browder, Timothy D. MD; Morrissey, Shawna L. DO; Fraser, Douglas R. MD; Ingalls, Nichole K. MD; Fildes, John J. MD

Journal of Trauma and Acute Care Surgery: June 2015 - Volume 78 - Issue 6 - p 1076–1085
doi: 10.1097/TA.0000000000000655
AAST 2014 Plenary Papers

BACKGROUND Laparoscopic techniques have evolved, allowing increased capabilities within most subspecialties of general surgery, but have failed to gain traction managing injured patients. We hypothesized that laparoscopy is effective in the diagnosis and treatment of penetrating abdominal injuries.

METHODS We retrospectively reviewed patients undergoing abdominal exploration following penetrating trauma at our Level 1 trauma center during a 6-year period from January 1, 2008, to December 31, 2013. Demographic and resuscitation data were obtained from our trauma registry. Charts were reviewed for operative details, hospital course, and complications. Hospital length of stay (LOS) and complications were primary end points. Patients were classified as having nontherapeutic diagnostic laparoscopy (DL), nontherapeutic diagnostic celiotomy (DC), therapeutic laparoscopy (TL), or therapeutic celiotomy (TC). TL patients were case-matched 2:1 with TC patients having similar intra-abdominal injuries.

RESULTS A total of 518 patients, including 281 patients (55%) with stab wounds and 237 patients (45%) with gunshot wounds, were identified. Celiotomy was performed in 380 patients (73%), laparoscopy in 138 (27%), with 44 (32%) converted to celiotomy. Nontherapeutic explorations were compared including 70 DLs and 46 DCs with similar injury severity. LOS was shorter in DLs compared with DCs (1 day vs. 4 days, p < 0.001). There were no missed injuries. Therapeutic explorations were compared by matching all TL patients 2:1 to TC patients with similar type and severity of injuries. Twenty-four patients underwent TL compared with 48 TC patients in the case matched group. LOS was shorter in the TL group than in the TC group (4 days vs. 2 days, p < 0.001). Wound infections were more common with open exploration (10.4% vs. 0%, p = 0.002), and more patients developed ileus or small bowel obstruction after open exploration (9.4% vs. 1.1%, p = 0.018).

CONCLUSION Laparoscopy is safe and accurate in penetrating abdominal injuries. The use of laparoscopy resulted in shorter hospitalization, fewer postoperative wound infection and ileus complications, as well as no missed injuries.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From Department of Surgery (T.D.B), Stanford University, Stanford, California; and Division of Trauma and Critical Care (P.J.C., S.L.M., D.R.F., N.K.I., J.J.F.), University of Nevada School of Medicine, Las Vegas, Nevada.

Submitted: August 12, 2014, Revised: February 17, 2015, Accepted: February 18, 2015.

T.D.B. and J.J.F. are members of the American Association for the Surgery of Trauma.

This study was presented at the 73rd annual meeting of the American Association for the Surgery of Trauma, September 9–13, 2014, in Philadelphia, Pennsylvania.

Address for reprints: Timothy D. Browder, MD, Department of Surgery, Stanford University, 300 Pasteur Dr, Grant Bldg, S-067, Stanford, CA 94305; email:

© 2015 Lippincott Williams & Wilkins, Inc.