Mandatory laparotomy for patients with abdominal stab wounds (ASWs) not only allows for the early detection of some expected injuries but also results in a higher unnecessary laparotomy rate, longer hospital stays, and increased hospital costs.Delayed laparotomy, however, increases mortality and morbidity. Therefore, the decision regarding when to operate on a patient with an ASW remains a challenge. Recent reports have demonstrated that diagnostic lap-aroscopy (DL) is useful for ASWs. In Japan, more than half of ASW patients are associated with suicide attempts because of psychiatric illnesses or mental disorders.6 Under these circumstances, physical examinations are sometimes unreliable so that DL should be frequently used in these patients. Even if DL prevents unnecessary laparotomy, it remains possible that these ASWs may subsequently develop ventral hernias.In addition, some cases of ASWs require an extended local wound that is as long as a laparotomy for direct fascial closure. Here, we report the laparoscopic repair of the abdominal wall using an Endoclose suturing device (Covidien, Mansfield, MA) when laparotomy is not needed according to DL.
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