Background:  If the patient of penetrating abdominal stab wound is hemodynamically  stable and has equivocal abdominal  examination findings,  surgeons pose a significant challenge to take decision in favor of surgery or nonoperative conservative treatment. This decision requires a precise diagnosis that is not always possible with imaging techniques. In consequence of this circumstance; laparoscopy can be a diagnostic or therapeutic tool in these cases. It also leads to avoid negative exploratory laparotomies. Methods: This is a randomized study including 51 patients with penetrating abdominal stab wounds. The patients were selected according to the following criteria; hemodynamically stable, no signs of peritonitis and fully conscious without evidence of raised intracranial pressure and absence of contraindication  for pneumoperitoneum. So we were able to evaluate the diagnostic and therapeutic role oflaparoscopy. Results: Patients were divided into two groups. Group I underwent exploratory laparotomy (26 patients). Group II underwent laparoscopic laparotomy (25 patients). The mean operating time in both groups  was (89±23.5  vs. 55±19 minutes,  (PO.05) respectively. There was no mortality in both groups. Accurate diagnosis was done to all patients in Group II except one patient (96.15%) with missed intestinal injury (this happened in the first cases of the study). Treatment was done for four patients from eight patients with discovered organ injuries (50%). Other four patients were converted to exploratory laparotomy (50%) due to severe injuries. Conclusion: The use oflaparoscopy as a diagnostic or therapeutic method in patients with penetrating abdominal stab wounds is an efficient, safe and effective method. The most important advantages are reduction of morbidity, shortening of hospitalization and cost-effectiveness.