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Use of Laparoscopy in Evaluation and Treatment of Penetrating and Blunt Abdominal Injuries

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Yuri W. Novitsky, MD

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, novitsky{at}uchc.edu

Richard A. Perugini, MD

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Liam Haveran, DO

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Donald Czerniach, MD

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

John J. Kelly, MD

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Demetrius E.M. Litwin, MD

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is evolving. The authors hypothesized that laparoscopy is safe and feasible as a diagnostic and therapeutic modality in both the patients with penetrating and blunt trauma. Trauma registry data and medical records of consecutive patients who underwent laparoscopy for abdominal trauma were reviewed. Over a 4-year period, 43 patients (18 blunt trauma / 25 penetrating trauma) underwent a diagnostic laparoscopy. Conversion to laparotomy occurred in 9 (50%) blunt trauma and 9 (36%) penetrating trauma patients. Diagnostic laparoscopy was negative in 33% of blunt trauma and 52% of penetrating trauma patients. Sensitivity/specificity of laparoscopy in patients with blunt and penetrating trauma was 92%/100% and 90%/100%, respectively. Overall, laparotomy was avoided in 25 (58%) patients. Use of laparoscopy in selected patients with blunt and penetrating abdominal trauma is safe, minimizes nontherapeutic laparotomies, and allows for minimal invasive management of selected intra-abdominal injuries.

Key Words: laparoscopy • penetrating trauma • blunt trauma • free fluid • therapeutic laparoscopy • negative laparotomy

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