Skip to main content
Log in

Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

General surgeons’ recent familiarity with advanced laparoscopic techniques have rendered laparoscopy feasible safely in the trauma setting. Traditionally high rates of nontherapeutic laparotomies also contribute to this increased interest. This study was undertaken to determine the predictive value and accuracy of diagnostic laparoscopy (DL) in evaluation of penetrating thoracoabdominal trauma.

Methods

Entry criteria included thoracoabdominal gunshot (GSW) or stab wounds (SW) in otherwise hemodynamically stable patients. A high index of suspicion for either hemoperitoneum, peritonitis, or diaphragmatic injury was required for inclusion. All patients underwent DL in the operating room followed by standard laparotomy. The findings of the two evaluations were compared.

Results

Twenty-four patients were included in the study. Twenty males and 4 females with an average age of 34 years made up the group. Violation of the peritoneal cavity was present in 21 cases and absent in 3. No intraabdominal injuries were found during laparotomy in the latter three cases without peritoneal violation. The specificity and positive predictive value were 100% for lesions of the diaphragm, liver, spleen, pancreas, kidney, and hollow viscus. The sensitivity was highest for liver and spleen injuries (88%), followed by diaphragmatic injuries (83%), pancreas and kidney injuries (50%), and lowest for injuries of hollow viscus (25%). The negative predictive value was 95, 99, 91, and 57%, respectively, for these organs.

Conclusions

DL could have avoided unnecessary laparotomy in 38% of cases in this study. There were no complications related to laparoscopy. The greatest value of DL in penetrating thoracoabdominal injuries is in the evaluation of peritoneal violation, diaphragmatic, and upper abdominal solid-organ injuries. It is not ideal for predicting hollow viscus injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Berci G, Sackier JM, Partlow MP (1991) Emergency laparoscopy. Am J Surg 161: 332–335

    Article  PubMed  CAS  Google Scholar 

  2. Brandt CP, Priebe PP, Jacobs DG (1994) Potential of laparoscopy to reduce nontherapeutic trauma laparotomies. Am Surg 6: 417–420

    Google Scholar 

  3. Demetriades D, Kakorjiannis S, Parekh D, Hatzitheofilou C (1988) Penetrating injuries of the diaphragm. Br J Surg 75: 824

    Article  PubMed  CAS  Google Scholar 

  4. Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds. Ann Surg 205: 129–132

    Article  PubMed  CAS  Google Scholar 

  5. Fabian TC, Croce MA, Steward RM, Pritchard FE, Minard Ag, Kudsk KA (1993) A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg 217: 557–565

    Article  PubMed  CAS  Google Scholar 

  6. Fernando HC, Alle KM, Davis CI, Klein SR (1994) Triage by laparoscopy in patients with penetrating abdominal trauma. Br J Surg 81: 384–385

    Article  PubMed  CAS  Google Scholar 

  7. Ivatury RR, Simon RJ, Stahl WM (1993) A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 34: 822–828

    PubMed  CAS  Google Scholar 

  8. Ivatury RR, Simon RJ, Weksler M, Bayard V, Stahl WM (1992) Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury. Trauma 33: 101–109

    CAS  Google Scholar 

  9. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36: 815

    PubMed  CAS  Google Scholar 

  10. Livingston DH, Tortella BJ, Blackwood J, Machiedo GW, Rush BJ (1992) The role of laparoscopy in abdominal trauma. J Trauma 33: 471–475

    PubMed  CAS  Google Scholar 

  11. Moore EE, Moore JB, Moore SV, Thompson JS (1980) Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 140: 847–850

    Article  PubMed  CAS  Google Scholar 

  12. Rossi P, Mullins D, Thal E (1993) Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg 166: 707–711

    Article  PubMed  CAS  Google Scholar 

  13. Salvino CK, Esposito TJ, Marshall WJ, Dries DJ, Morris RC, Gamelli RL (1993) The role of diagnostic laparoscopy in the management of trauma patients: a preliminary assessment. J Trauma 34: 506–515

    PubMed  CAS  Google Scholar 

  14. Shorr RM, Gottlieb MM, Webb K, Ishigura L, Berne TV (1988) Selective management of abdominal stab wounds. Arch Surg 123: 1141–1145

    PubMed  CAS  Google Scholar 

  15. Sosa JL, Baker M, Puente I, Sims D, Sleeman D, Ginzburg E, Martin L (1995) Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy. J Trauma 38: 194–197

    PubMed  CAS  Google Scholar 

  16. Taylor FW (1973) Gunshot wounds of the abdomen. Ann Surg 177: 174

    Article  PubMed  CAS  Google Scholar 

  17. Thal ER (1977) Evaluation of peritoneal lavage and local exploration of lower chest and abdominal stab wounds. Trauma 17: 642

    Article  CAS  Google Scholar 

  18. Townsend MC, Flancbaum L, Chaban PS, Cloutier CT (1993) Diagnostic laparoscopy as an adjunct to selective conservative management of solid organ injuries after blunt abdominal trauma. J Trauma 35: 647–653.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

This study was funded by a grant from Karl Storz (Culver City, CA) Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons, (SAGES), Orlando, Florida, USA, 11–14 March 1995

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ortega, A.E., Tang, E., Froes, E.T. et al. Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries. Surg Endosc 10, 19–22 (1996). https://doi.org/10.1007/s004649910003

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004649910003

Key words

Navigation