CONTROVERSY

14. What is the role of laparoscopy and thoracoscopy after penetrating abdominal trauma?

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Although an intriguing diagnostic modality with additional therapeutic capabilities, laparoscopy thus far appears to have limited application after trauma. With the exception of suspected diaphragmatic injury, an isolated solid organ injury, or evaluation for peritoneal penetration, laparoscopy has yet to demonstrate advantages over the algorithm delineated above. The potential for missed injuries, poor evaluation of the retroperitoneum, and expense are major drawbacks. In patients with wounds to the lower chest with pneumothorax (and, thus, an indication for chest tube placement), thoracoscopy is reasonable to exclude diaphragmatic injury.

References
WEB SITES

1. http://www.east.org/tpg/atbpenetra.pdf
2. http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/abdominal_stab.htm

BIBLIOGRAPHY
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