The use of laparoscopy as a primary diagnostic and therapeutic method in penetrating wounds of lower thoracal region

Abstract

Diagnostic laparoscopy (DL) was found to be a sensitive and specific method that reduced the incidence of negative or nontherapeutic laparotomy in patients having penetrating abdominal trauma. Twenty-two patients with penetrating trauma of the lower thoracal region were evaluated by DL at the Emergency Department of the Istanbul Medical Faculty to decide on either laparotomy or conservative treatment. There were 7 (31.8%) female and 15 (68.2%) male patients, Mean age was 26.5 (21-46) years. Three (13.6%) patients had gunshot wounds and 19 (86.4%) stab injuries. No peritoneal penetration was detected by DL in 11 (50%) patients, and none of these patients later required laparotomy. Of the remaining 11 patients who had peritoneal penetration, diaphragmatic laceration was detected in 9 (81.8%). Nineteen patients (86.4%) avoided nontherapeutic laparotomy. The specificity and sensitivity of DL were 100% in lower thoracal penetrating trauma. The positive diagnostic value and negative predictive value for peritoneal penetration were found to be 100%, The positive predictive value for therapeutic laparotomy and negative predictive value for nontherapeutic laparotomy were 100% as well. All patients who underwent only DL was discharged within 24 hours. There were no mortality or morbidity. Mean followup period was 13 months, and no associated complication was encountered during this time.