Laparoscopic exploration and lavage in penetrating abdominal stab wounds: a preliminary report

Abstract

Background: To determine the role of a combined laparoscopic exploration and lavage (LELA) in abdominal stab wounds (ASW). We hypothesized that peritoneal penetration (PP) is not an indication for exploratory laparotomy (EL) if LELA is negative.

Methods: A prospective study (Jan 2002-Dec 2003) was carried at our Level I Trauma Center. Patients with anterior fascia penetration in wound exploration and with systolic blood pressure greater than 90 mmHg were included. Patients with back and flank injuries, evisceration and presentation after six hours were excluded. LELA was considered positive if red blood cell count was >5000 and white blood cell count was >150 in a lavage without the presence of bile, gross blood, food fibers or stool.

Results: Eighty-nine patients with anterior ASW (AASW) were included. Twenty-eight patients underwent laparoscopy to rule out PP. Seventeen patients had PP and 8 demonstrated injuries that required immediate exploratory laparotomy. The remaining 9 underwent LELA. Four patients had positive LELA that demonstrated injuries (sigmoid, right colon, and small bowel [n: 2]). Five patients had a negative LELA and avoided an unnecessary EL.

Conclusion: LELA in AASW shows a promising role to rule out mainly hollow viscus injuries. This technique could decrease the number of non-therapeutic laparotomies, length of stay and hospital costs without increasing the incidence of missed abdominal injuries.