A prospective analysis of diagnostic laparoscopy in trauma

Timothy C. Fabian, Martin A. Croce, Ronald M Stewart, F. Elizabeth Pritchard, Gayle Minard, Kenneth A. Kudsk

Research output: Contribution to journalArticle

195 Citations (Scopus)

Abstract

Objective: This study was performed to assess current and potential future application for laparoscopy (DL) in the diagnosis of penetrating and blunt injuries. Efficacy, safety, and cost analyses were performed. Summary Background Data: Diagnostic peritoneal lavage (DPL) and computed tomography (CT) have been the mainstays in recent years for diagnosis of equivocal nontherapeutic laparotomy, whereas CT is not helpful tor the vast majority of penetrating wounds. DL may be a useful adjunct to fill in these gaps. Methods: Hemodynamically stable patients with equivocal evidence of intraabdominal injury were prospectively entered into the protocol. DL was performed under general anesthesia; patients with wounds penetrating the peritoneum or blunt injury with significant organ injury underwent laparotomy. Results: Over 19 months, 182 patients (55% stab, 36% GSW, 9% blunt) were studied. No peritoneal penetration was found at DL in 55% of penetrating wounds with 66% of the remainder having therapeutic laparotomy, 17% nontherapeutic laparotomy, and 17% negative laparotomy. Therapeutic laparotomy was performed in 53% of blunt injuries after DL. Tension pneumothorax occurred in one patient and one had an iatrogenic small bowel injury. Charges for DL were $3,325 per patient compared with $3,320 for a similar group undergoing negative laparotomy before this protocol. Conclusions: DL is a safe modality for trauma. With current technology, DL is most efficacious for evaluation of equivocal penetrating wounds. Significant cost savings would be gained by performance under local anesthesia. Development of miniaturized optics, bowel clamps, retractors, and stapling devices will reduce overall costs and permit some therapeutic applications for laparoscopy in trauma management.

Original languageEnglish (US)
Pages (from-to)557-565
Number of pages9
JournalAnnals of Surgery
Volume217
Issue number5
StatePublished - May 1993
Externally publishedYes

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Laparoscopy
Laparotomy
Penetrating Wounds
Wounds and Injuries
Nonpenetrating Wounds
Tomography
Peritoneal Lavage
Costs and Cost Analysis
Cost Savings
Peritoneum
Pneumothorax
Local Anesthesia
General Anesthesia
Therapeutics
Technology
Safety
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery

Cite this

Fabian, T. C., Croce, M. A., Stewart, R. M., Pritchard, F. E., Minard, G., & Kudsk, K. A. (1993). A prospective analysis of diagnostic laparoscopy in trauma. Annals of Surgery, 217(5), 557-565.

A prospective analysis of diagnostic laparoscopy in trauma. / Fabian, Timothy C.; Croce, Martin A.; Stewart, Ronald M; Pritchard, F. Elizabeth; Minard, Gayle; Kudsk, Kenneth A.

In: Annals of Surgery, Vol. 217, No. 5, 05.1993, p. 557-565.

Research output: Contribution to journalArticle

Fabian, TC, Croce, MA, Stewart, RM, Pritchard, FE, Minard, G & Kudsk, KA 1993, 'A prospective analysis of diagnostic laparoscopy in trauma', Annals of Surgery, vol. 217, no. 5, pp. 557-565.
Fabian TC, Croce MA, Stewart RM, Pritchard FE, Minard G, Kudsk KA. A prospective analysis of diagnostic laparoscopy in trauma. Annals of Surgery. 1993 May;217(5):557-565.
Fabian, Timothy C. ; Croce, Martin A. ; Stewart, Ronald M ; Pritchard, F. Elizabeth ; Minard, Gayle ; Kudsk, Kenneth A. / A prospective analysis of diagnostic laparoscopy in trauma. In: Annals of Surgery. 1993 ; Vol. 217, No. 5. pp. 557-565.
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