This prospective study was designed to examine whether or not laparoscopy prior to exploratory celiotomy is a useful method for abdominal evaluation in the trauma patients.
The authors conducted diagnosis or treatment in laparoscopy on 20 cases of hemodynamically stable abdominal trauma patients in which exploration considered on the basis of clinical evaluation, positive diagnostic peritoneal lavage and/or
computerized
tomographic findings was suggestive of significant intra-abdominal organ injury at Wonkwang University Hospital from August 1994 to July 1995.
Seven of 20(35%) patients with abdominal trauma were treated with laparoscopy only without exploratory celiotomy. Two of 9(22%) patients with blunt abdominal trauma and one of 4(25%) patients with penetrating abdominal trauma had significant
injuries
that were found at the time of operation but were not visualized during laparoscopy. The missed injuries involved the pancreas, and small bowel. Their incision methods were 5 kinds and the average length of the incision was 13cm. Incision methods
of
control group (Exploration was performed directly without preoperative laparoscopy) were 2 kinds, long upper- or mid-midline, and the average length of the incision was 21 cm.
We summarized that ① Disadvantage of laparoscopy is difficult to diagnose injury of retroperitoneal organ, ② Laparoscopy allow unnecessary celiotomy and laparoscopic therapeutic procedure in abdominal trauma patients, ③ Laparoscopy made choice
of
optimal incision following injuried organ and performed less incision than exploratory celiotomy. ④Emergency laparoscopies were performed mostly by residents; therefore, the credentialed staff use laparoscopy, so exploratory celiotomy should be
reduced. From our results, we feel preoperative laparoscopy is a very useful adjuvant method in abdominal trauma patients.
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