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Surgical Endoscopy

, Volume 14, Issue 10, pp 930–937 | Cite as

Diagnostic laparoscopy for the acute abdomen and trauma

  • W. Majewski
Original Articles

Abstract

Background

We set out to investigate the potential benefits of routine diagnostic laparoscopy (DL) in cases of acute abdomen.

Methods

A prospective study of 120 DL in acute abdominal cases was performed in comparison with 310 similar acute abdominal cases treated without DL. The diagnostic accuracy, hospital stay, therapeutic delay, and convalescence time were then evaluated.

Results

DL established the indications for intervention in 96% of cases, yielded a diagnosis in 90%, and changed the treatment in 14%. The sensitivity achieved was 99.3%, specificity was 83.3%, and accuracy was 88.6%. There were two false positives, one false negative, and three results insufficient to make a diagnosis. Morbidity was one (0.8%), and mortality was one (0.8%). Seventy-nine patients (66%) were managed by laparoscopy and 24 by open interventions. The hospital stay in DL groups was shorter (median, 5 days vs 6 days in controls, p<0.0003), as was the effective treatment time (median, 5 days vs 6 days, p<0.0012). The convalescence time was also shorter in DL groups (median, 14 days vs 14 days, p<0.04). Therapeutic delay occurred in 16% of the control group cases, doubling the morbidity rate, increasing mortality by 50%, and prolonging hospital stay (median, 9 days vs 6 days, p>0.3 (NS).

Conclusions

DL in the acute abdomen is a safe and accurate procedure that enables laparoscopic interventions and helps avoid nontherapeutic surgery. DL and appropriate treatment reduces hospital stay, therapeutic delay, and convalescence time.

Key words

Diagnostic laparoscopy Acute abdomen Abdominal trauma 

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References

  1. 1.
    Brandt CP, Priebe PP, Eckhauser ML (1993) Diagnostic laparoscopy in the intensive care patient, avoiding the non-therapeutic laparotomy. Surg Endosc 7: 168–172CrossRefGoogle Scholar
  2. 2.
    Box JC, Duncan T, Ramshaw B, Tucker JG, Mason EM, Wilson JP, Melton D, Lucas GW (1997) Laparoscopy in the evaluation and treatment of patients with AIDS and acute abdominal complaints. Surg Endosc 11: 1026–1028CrossRefGoogle Scholar
  3. 3.
    Chia-Ming C, Shi-Ming L, Shyn-Ming P, Cheng-Shyong W, Yun-Fan L (1994) The role of laparoscopy in the evaluation of ascites of unknown origin. Gastrointest Endosc. 40: 285–289CrossRefGoogle Scholar
  4. 4.
    Chung RS, Diaz JJ, Chiari V (1998) Efficacy of routine laparoscopy for the acute abdomen. Surg Endosc 12: 219–222CrossRefGoogle Scholar
  5. 5.
    Cuesta MA, Eijsbouts OAJ, Gordijn RV, Borgstein PJ, DeJong D (1998) Diagnostic laparoscopy in patients with an acute abdomen of uncertain etiology. Surg Endosc 12: 915–917CrossRefGoogle Scholar
  6. 6.
    Cueto J, Diaz O, Garteiz D, Rodriguez M, Weber A (1997) The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitis. Surg Endosc 11: 366–370CrossRefGoogle Scholar
  7. 7.
    Ditmars ML, Bongard F (1996) Laparoscopy for triage of penetrating trauma: the decision to explore. J Laparosc Endosc 6: 285–291CrossRefGoogle Scholar
  8. 8.
    Easter DW, Cuschieri A, Nathanson LK, Lavelle-Jones M (1992) The utility of diagnostic laparoscopy for abdominal disorders. Arch Surg 27: 379–383CrossRefGoogle Scholar
  9. 9.
    Geiss WP, Kim HC (1995) Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. Surg Endosc 9: 178–182Google Scholar
  10. 10.
    Halverson A (1998) Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc 12: 266–266CrossRefGoogle Scholar
  11. 11.
    Hauser CJ, Poole GV, Thomae KR (1996) Laparoscopic surgery and the management of traumatic hemoperitoneum in stable patients [Letter]. Surg Endosc 10: 694CrossRefGoogle Scholar
  12. 12.
    Lepaniemi AK, Eliot DC (1996) The role of laparoscopy in blunt abdominal trauma. Ann Med 28: 483–489CrossRefGoogle Scholar
  13. 13.
    Livingston DH, Tortella BJ, Blackwood J, Machiedo GW, Rush BF (1992) The role of laparoscopy in abdominal trauma. J Trauma 33: 471–475CrossRefGoogle Scholar
  14. 14.
    Lujan-Mompean JA (1995) Laparoscopic surgery in the management of traumatic hemoperitoneum in stable patients. Surg Endosc 9: 879PubMedGoogle Scholar
  15. 15.
    Marks JM, Youngelmann D, Teri Berk F (1997) Cost analysis of diagnostic laparoscopy versus laparotomy in the evaluation of penetrating abdominal trauma. Surg Endosc 11: 272–276CrossRefGoogle Scholar
  16. 16.
    Nagy AG, James D (1989) Diagnostic laparoscopy. Am J Surg 157: 490–493CrossRefGoogle Scholar
  17. 17.
    Ogbonna BC, Obekpa PO, Momoh JT, Obafunwa JO, Nwana EJ (1992) Laparoscopy in developing countries, in the management of patients with an acute abdomen. Br J Surg 79: 964–966CrossRefGoogle Scholar
  18. 18.
    Orlando III R, Crowell KL (1997) Laparoscopy in the critically ill. Surg Endosc 11: 1072–1074CrossRefGoogle Scholar
  19. 19.
    Paterson-Brown S (1993) Emergency laparoscopic surgery. Br J Surg 80: 279–283CrossRefGoogle Scholar
  20. 20.
    Rossi P, Mulins D, Thal E (1993) Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg 166: 707–711CrossRefGoogle Scholar
  21. 21.
    Salky BA, Edye MB (1998) The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes. Surg Endosc 12: 911–914CrossRefGoogle Scholar
  22. 22.
    Schrenk P, Woisetschlager R, Wayand WU, Rieger R, Sulzbacher H (1994) Diagnostic laparoscopy: a survey of 92 patients. Am J Surg 168: 348–351CrossRefGoogle Scholar
  23. 23.
    Van der Velpen GC, Shimi SM, Cushieri A (1994) Diagnostic yield and management benefit of laparoscopy: a prospective audit. Gut 35: 1617–1621CrossRefGoogle Scholar
  24. 24.
    Zantut LF (1997) Diagnostic and therapeutic laparoscopy for a penetrating abdominal trauma. J Trauma 42: 825–177CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • W. Majewski
    • 1
  1. 1.Department of General Surgery and TransplantationPomeranian Medical UniversitySzczecinPoland

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