Delayed Laparotomy After Selective Non-operative Management of Penetrating Abdominal Injuries

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2014 Oct 4

PMID 25277981

Citations 6

Authors

Miroslav P Peev

Yuchiao Chang

David R King

Daniel D Yeh

Haytham Kaafarani

Peter J Fagenholz

Marc A de Moya

George C Velmahos

Affiliations

Soon will be listed here.

Abstract

Background: Main concern during the practice of selective non-operative management (SNOM) for abdominal stab wounds (SW) and gunshot wounds (GSW) is the potential for harm in patients who fail SNOM and receive a delayed laparotomy (DL). The aim of this study is to determine whether such patients suffer adverse sequelae because of delays in diagnosis and treatment when managed under a structured SNOM protocol.

Methods: 190 patients underwent laparotomy after an abdominal GSW or SW (5/04-10/12). Patients taken to operation within 120 min of admission were included in the early laparotomy (EL) group (n =153, 80.5 %) and the remaining in the DL group (n =37, 19.5 %). Outcomes included mortality, hospital stay, and postoperative complications.

Results: The median time from hospital arrival to operation was 43 min (range: 17-119) for EL patients and 249 min (range: 122-1,545) for DL patients. The average number and type of injuries were similar among the groups. Mortality and negative laparotomy were observed only in the EL group. There was no significant difference in the hospital stay between the groups. The overall complications were higher in the EL group (44.4 vs. 24.3 %, p =0.026). DL was independently associated with a lower likelihood for complications (OR 0.39, 95 % CI 0.16-0.98, p =0.045). Individual review of all DL patients did not reveal an incident in which complications could be directly attributed to the delay.

Conclusions: In a structured protocol, patients who fail SNOM and require an operation are recognized and treated promptly. The delay in operation does not cause unnecessary morbidity or mortality.

Citing Articles

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Sander A, Spence R, Ellsmere J, Hoogerboord M, Edu S, Nicol A Eur J Trauma Emerg Surg. 2020; 48(2):881-889.

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Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization.

Hietbrink F, Smeeing D, Karhof S, Jonkers H, Houwert M, van Wessem K World J Emerg Surg. 2019; 14:40.

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References

Velmahos G, Demetriades D, CORNWELL E, Asensio J, Belzberg H, Berne T . Gunshot wounds to the buttocks: predicting the need for operation. Dis Colon Rectum. 1997; 40(3):307-11. DOI: 10.1007/BF02050420. View

Schnuriger B, Lam L, Inaba K, Kobayashi L, Barbarino R, Demetriades D . Negative laparotomy in trauma: are we getting better?. Am Surg. 2012; 78(11):1219-23. View

Sosa J, Arrillaga A, Puente I, Sleeman D, Ginzburg E, Martin L . Laparoscopy in 121 consecutive patients with abdominal gunshot wounds. J Trauma. 1995; 39(3):501-4; discussion 504-6. DOI: 10.1097/00005373-199509000-00017. View

Velmahos G, Demetriades D, Foianini E, Tatevossian R, Cornwell 3rd E, Asensio J . A selective approach to the management of gunshot wounds to the back. Am J Surg. 1997; 174(3):342-6. DOI: 10.1016/s0002-9610(97)00098-6. View

Hope W, Smith S, Medieros B, Hughes K, Kotwall C, Clancy T . Non-operative management in penetrating abdominal trauma: is it feasible at a Level II trauma center?. J Emerg Med. 2011; 43(1):190-5. DOI: 10.1016/j.jemermed.2011.06.060. View

Zafar S, Zafar S, Rushing A, Haut E, Kisat M, Villegas C . Outcome of selective non-operative management of penetrating abdominal injuries from the North American National Trauma Database. Br J Surg. 2012; 99 Suppl 1:155-64. DOI: 10.1002/bjs.7735. View

McAlvanah M, Shaftan G . Selective conservatism in penetrating abdominal wounds: a continuing reappraisal. J Trauma. 1978; 18(3):206-12. DOI: 10.1097/00005373-197803000-00010. View

Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D . Gunshot wound of the abdomen: role of selective conservative management. Br J Surg. 1991; 78(2):220-2. DOI: 10.1002/bjs.1800780230. View

Velmahos G, Demetriades D, Toutouzas K, Sarkisyan G, Chan L, Ishak R . Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care?. Ann Surg. 2001; 234(3):395-402; discussion 402-3. PMC: 1422030. DOI: 10.1097/00000658-200109000-00013. View

10.

Fikry K, Velmahos G, Bramos A, Janjua S, de Moya M, King D . Successful selective nonoperative management of abdominal gunshot wounds despite low penetrating trauma volumes. Arch Surg. 2011; 146(5):528-32. DOI: 10.1001/archsurg.2011.94. View

11.

Shaftan G . Selective conservatism in penetrating abdominal trauma. J Trauma. 1969; 9(12):1026-8. DOI: 10.1097/00005373-196912000-00014. View

12.

Demetriades D, Velmahos G, Cornwell 3rd E, Berne T, Cober S, Bhasin P . Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg. 1997; 132(2):178-83. DOI: 10.1001/archsurg.1997.01430260076017. View

13.

Laing G, Skinner D, Bruce J, Bekker W, Oosthuizen G, Clarke D . A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre. Injury. 2013; 45(1):327-32. DOI: 10.1016/j.injury.2013.08.021. View

14.

Velmahos G, Demetriades D, Cornwell 3rd E . Transpelvic gunshot wounds: routine laparotomy or selective management?. World J Surg. 1998; 22(10):1034-8. DOI: 10.1007/s002689900512. View

15.

Como J, Bokhari F, Chiu W, Duane T, Holevar M, Tandoh M . Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010; 68(3):721-33. DOI: 10.1097/TA.0b013e3181cf7d07. View

16.

Lowe R, Saletta J, READ D, Radhakrishnan J, Moss G . Should laparotomy be mandatory or selective in gunshot wounds of the abdomen?. J Trauma. 1977; 17(12):903-7. DOI: 10.1097/00005373-197712000-00003. View

17.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

18.

Moore E, Moore J, Thompson J . Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg. 1980; 140(6):847-51. DOI: 10.1016/0002-9610(80)90130-0. View