Selective celiotomy for missile wounds of the abdomen based on laparoscopy.

The role of laparoscopy in the selective management of gunshot wounds (GSW) of the abdomen was prospectively investigated in 38 patients. All the patients were hemodynamically stable and had equivocal evidence of intraabdominal penetration. Laparoscopy was performed in the operating room under anesthesia. The site of penetration was in the thoracoabdominal area in 13, epigastrium in 7, and lower quadrants in 18. Twenty-three (60.5%) had nonpenetration on laparoscopy and a laparotomy was avoided. The remaining patients had injuries to the liver (4 patients), spleen (two patients), diaphragm (3 patients), hemoperitoneum or retroperitoneal hematoma (6 patients), and hollow viscus injuries (5 patients). Laparoscopy was also helpful in determining the need for laparotomy vs thoracotomy in lower chest wounds. The negative laparoscopy group (no penetration) had a significantly lower hospital stay compared to hemodynamically stable patients who had negative laparotomy without laparoscopy for nonpenetrating GSW. There were no complications related to laparoscopy. Laparoscopy is a useful modality in the evaluation of hemodynamically stable patients with abdominal missile wounds.