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Laparoscopic
Diagnostic Peritoneal Lavage (L-DPL):
A New
Protocol for Thoracoabdominal and Abdominal Penetrating Injuries
Benyamine Abbou, Shlomo H.
Israelit, Dan D. Hershko, Daniel S. Duek, Bishara Bishara, Michael M.
Krausz
Department of Surgery A', Rambam
Medical Center,
and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel
Background: Penetrating abdominal stab
wounds in hemodynamically stable patients are usually managed by mandatory
laparotomy. Diagnostic laparoscopy (DL) is reserved for thoracoabdominal
injuries. If penetration to the abdominal cavity is found A mandatory
laparotomy is preformed (exept for small diaphragmatic laceration above the
liver). Laproscopy alone without laprotomy is not commonly used in
evaluation of proven penetrating abdominal wounds, because trauma surgeons
with only basic experience in laparoscopy cannot be assured that
significant injury was not missed.
Method: Eleven hemodynamically stable
trauma patients with thoracoabdominal or abdominal stab wounds are hereby
described. Diagnostic laparoscopy was performed to prove peritoneal
penetration, assess the severity of intra-abdominal injuries, control of
bleeding vessels, and repair of lacerations of the diaphragm. When
significant injury was excluded, laparoscopic diagnostic peritoneal lavage
(L-DPL) was performed through the laparoscopic port, and the lavage fluid return was examined for
feces, bile, food, bacteria, WBC counts, and amylase. An Abdominal drain
was placed in all cases for additional observation.
Results: Between 08.2003 and 09.2004, 7
patients with thoracoabdominal stab wounds (63%) and 4 patients with
anterior abdomen stab wounds (37%) underwent diagnostic laproscopy (DL).
Peritoneal violation was diagnosed in 8 (72%) patients and the L-DPL was
preformed with 7 patients. All the lavage fluid analyses were negeative
except for a high RBC count whice ranged from 10,000 to 160,000 cells/mcrl
whice was not an indication for laprotomy. One patient underwent laparotomy
because of a diaphragmatic and gastric tear in the intial laproscopy.
Diaphragmatic tears were repaired laparoscopically in 2 patients. All patients recovered uneventfully.
Conclusions: A method of laparoscopic
diagnostic peritoneal lavage (L-DPL), for evaluation and treatment of
hemodynamically stable trauma patients with penetrating thoracoabdominal or
abdominal stab wounds, is described. This procedure combines the safety and
anatomic detail provided by laparoscopy with the sensitivity and
specificity of DPL. It is therefore expected that this procedure will
decrease the number of non-therapeutic open laparotomies in those cases.
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