The treatment of patients with anterior abdominal stab wounds remains controversial. We reserve celiotomy for patients who have clinical findings of peritonitis or hemorrhage. Repeated physical examination is the most important element of observation. Recently, 330 patients with stable abdominal stab wounds presented over a 12-month period. These patients were followed up with serial physical examinations and laboratory measurements. Of the 330 patients, 107 patients (32%) required celiotomy for the repair of a life-threatening injury (group 1); 28 patients (8%) underwent nontherapeutic celiotomies (group 2); 19 patients (6%) had negative explorations (group 3); and 176 patients (53%) were observed and discharged (group 4). There were three missed injuries in group 4. Serial physical examination can be a reliable technique in the management of abdominal stab wounds and is comparable to other approaches.