Role of Laparoscopic Exploration Under Local Anesthesia in the Management of Hemodynamically Stable Patients with Penetrating Abdominal Injury.

BACKGROUND: In many trauma centers there is an ongoing controversy over the way of managing patients with penetrating abdominal injuries. This study was constructed to evaluate the role of diagnostic laparoscopy performed with local anesthesia for the management of penetrating abdominal injury.

PATIENTS AND METHODS: Thirty hemodynamically stable patients with a penetrating stab wound in the anterior abdominal wall were included in this study after consent was obtained. Laparoscopic explorations were done with the patient having local anesthesia. If there was bleeding or intestinal content in the peritoneal cavity or visible injury to any abdominal organ, the procedure was converted to open exploration. If the peritoneal cavities showed no fluid and there was no injury to the abdominal viscera, the patient was followed up for the next 72 hours. Continuous variables were expressed as mean and standard deviation values. Categorical variables were expressed as frequencies and percentages. Student's t test was used to assess the statistical significance of the difference between the two study groups' means. Fisher's exact test was used to examine the relationship between categorical variables. A significance level of P < .05 was used in all tests. All statistical procedures were carried out using SPSS version 20 for Windows software (IBM, Armonk, NY).

RESULTS: From the total of 30 patients who underwent laparoscopic exploration, 13 patients (43.3%) needed open exploration: 11 cases had intrabdominal organ injuries that needed laparotomy, 1 case had intraperitoneal blood collection where the only source of blood was the anterior abdominal wall wound, and 1 case had acute abdominal pain after 48 hours of negative laparoscopic exploration, in which an intestinal tear was found upon re-exploration. For the other 17 (56.7%) cases, 3 cases had no peritoneal penetration, whereas 14 cases had peritoneal penetration without any internal organ injuries, and these patients were followed up and discharged after 2-3 days.

CONCLUSIONS: Laparoscopy performed with the patient having local anesthesia is an accurate diagnostic tool in the management of patients with an equivocal penetrating stab wound in the abdominal wall and can reduce the number of patients with negative open exploration.