Introduction: Exploratory laparotomy in either blunt or penetrating abdominal trauma with suspected intra-abdominal injuries is associated with a high negative (non-therapeutic) laparotomy rate and a high procedure-related morbidity. In abdominal trauma, laparoscopy may be used either as a diagnostic or therapeutic tool in hemodynamically stable patients. Laparoscopy can avoid unnecessary (non-therapeutic) laparotomy and may allow laparoscopic repair of these injuries. Diagnostic laparoscopy can reliably rule out a significant intra-abdominal injury in patients with equivocal abdominal examination following trauma. In sharp abdominal trauma laparoscopy has been shown to be very effective in determining violation of the peritoneal cavity by tangential wounds.   Patients and methods: 38 patients with abdominal trauma were enrolled for this study. Exclusion criteria for all patients included; hemodynamic instability, clinical or radiological evidence of major abdominal organs or vascular injuries, posterior abdominal wall penetrating injuries, bowel evisceration, evidence of   2   thoracic injuries (as pneumothorax), or head injuries. Pneumo-peritoneum is achieved with low CO
flow   and maintained at low pressures (10–12 mmHg). We started by exploration of abdominal cavity and suction of the free blood from the peritoneal cavity. In sharp injuries, inspection of the peritoneal membrane was done for evidence of penetration. Small hepatic and splenic hematomas were left undisturbed. Small and accessible tears ware sutured. Deep or inaccessible liver and splenic tears needed conversion to laparotomy. Small intestinal simple tears were sutured laparoscopically while complex tears needed laparotomy conversion. Left colonic tears needed laparotomy conversion and colonic diversion.   Results:  Patients with blunt trauma (26 patients), in whom laparoscopic management was completed were18 patients (69%). 5 patients (26%) of the later, had negative laparoscopic exploration, for which the operations were terminated, 6 patients (37%) had retroperitoneal hematomas with free hemo-peritoneum, 2 cases (10.5%) showed only right hepatic lobe small sub-capsular hematomas, 3 cases (16%) showed small liver tears, and 2 cases (10.5%) showed small splenic sub-capsular hematomas and small superficial tear. All the previous injuries were left undisturbed with laparoscopic suturing of the 2 cases with liver tears. 12 cases (31.5%) with sharp penetrating anterior abdominal wall trauma were included in this study. The cases with penetrating abdominal trauma that could be completed laparoscopically were 8 cases (67%) and those who needed laparotomy conversion were 4 cases (33%). The mean operative time in the cases that were completed laparoscopically was 85 minutes and in the laparotomy converted group was 67 minutes. Analysis of postoperative pain in all patients was done using the Numeric Rating Scale (NRS) for pain. Pain was subjectively more severe and statistically different in the laparotomy group than laparoscopic group. The range of hospital stay in the laparoscopy group was 2 to 5 days, and in the laparotomy group it was from 6 to 8 days. No cases in the laparoscopy group showed wound infection; while it was 3 cases (25%) in the laparotomy converted group. Long term follow up showed one case (8.3%) in the laparotomy group developed incisional hernia related to the main abdominal wound, while no similar case was detected in the laparoscopy completed group.   Conclusion:  The evaluation and management of abdominal trauma are multi-factorial. Careful selection of trauma patients, high index of suspicion, and a low threshold for laparotomy will provide them the benefits of laparoscopic management and reduce the rates and morbidity of unnecessary laparotomy.