Role of Laparoscopy in Management of Patients with Anterior Abdominal Stab Wounds

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2023 Oct 13

PMID 37833508

Authors

Chien Wu

Keng-Li Lin

Yin-Jen Chang

Heng-Fu Lin

Affiliations

Soon will be listed here.

Abstract

Background: In this retrospective cohort study, we assessed the utility of laparoscopic surgery for diagnostic and therapeutic purposes in patients with anterior abdominal stab wounds (AASWs). We also investigated patient characteristics that might suggest a greater suitability of laparoscopic interventions.

Methods: Over a 25-year span, we analyzed AASW patients who had operations, categorizing them based on the presence of significant intra-abdominal injuries and whether they received laparoscopic surgery or laparotomy. We compared variables such as preoperative conditions, surgical details, and postoperative outcomes. We further evaluated the criteria indicating the necessity of direct laparotomies and traits linked to overlooked injuries in laparoscopic surgeries.

Results: Of 142 AASWs surgical patients, laparoscopic surgery was conducted on 89 (62.7%) patients. Only 2 (2.2%) had overlooked injuries after the procedure. Among patients without significant injuries, those receiving laparoscopic surgery had less blood loss than those receiving laparotomy (30.0 vs. 150.0 ml, p = 0.004). Patients who underwent laparoscopic surgery also had shorter hospital stays (significant injuries: 6.0 vs. 11.0 days, p < 0.001; no significant injuries: 5.0 vs. 6.5 days, p = 0.014). Surgical complications and overlooked injury rates were comparable between both surgical methods. Bowel evisceration correlated with higher laparotomy odds (odds ratio = 16.224, p < 0.001), while omental evisceration did not (p = 0.107).

Conclusions: Laparoscopy is a safe and effective method for patients with AASWs, fulfilling both diagnostic and therapeutic needs. For stable AASW patients, laparoscopy could be the preferred method, reducing superfluous nontherapeutic laparotomies.

References

Demetriades D, Rabinowitz B . Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg. 1987; 205(2):129-32. PMC: 1492835. DOI: 10.1097/00000658-198702000-00005. View

Moore E, Marx J . Penetrating abdominal wounds. Rationale for exploratory laparotomy. JAMA. 1985; 253(18):2705-8. View

Paydar S, Salahi R, Izadifard F, Jaafari Z, Abbasi H, Eshraghian A . Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound. Am J Emerg Med. 2011; 30(7):1146-51. DOI: 10.1016/j.ajem.2011.08.012. View

Omari A, Bani-Yaseen M, Khammash M, Qasaimeh G, Eqab F, Jaddou H . Patterns of anterior abdominal stab wounds and their management at Princess Basma teaching hospital, North of Jordan. World J Surg. 2013; 37(5):1162-8. DOI: 10.1007/s00268-013-1931-y. View

Leppaniemi A, Salo J, Haapiainen R . Complications of negative laparotomy for truncal stab wounds. J Trauma. 1995; 38(1):54-8. DOI: 10.1097/00005373-199501000-00016. View

Weigelt J, Kingman R . Complications of negative laparotomy for trauma. Am J Surg. 1988; 156(6):544-7. DOI: 10.1016/s0002-9610(88)80549-x. View

MORRISON J, Wisner D, Bodai B . Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization. J Trauma. 1996; 41(3):509-13. DOI: 10.1097/00005373-199609000-00021. View

Buisset C, Mazeaud C, Postillon A, Nomine-Criqui C, Fouquet T, Reibel N . Evaluation of diagnostic laparoscopy for penetrating abdominal injuries: About 131 anterior abdominal stab wound. Surg Endosc. 2021; 36(5):2801-2808. DOI: 10.1007/s00464-021-08566-z. View

Zantut L, Ivatury R, Smith R, Kawahara N, Porter J, Fry W . Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma. 1997; 42(5):825-9; discussion 829-31. DOI: 10.1097/00005373-199705000-00012. View

10.

OMalley E, Boyle E, OCallaghan A, Coffey J, Walsh S . Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg. 2012; 37(1):113-22. DOI: 10.1007/s00268-012-1790-y. View

11.

Lin H, Wu J, Tu C, Chen H, Shih H . Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg. 2010; 34(7):1653-62. DOI: 10.1007/s00268-010-0485-5. View

12.

Bain K, Meytes V, Chang G, Timoney M . Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Surg Endosc. 2018; 33(5):1618-1625. DOI: 10.1007/s00464-018-6436-1. View

13.

Marks J, Ramey R, Baringer D, Aszodi A, Ponsky J . Laparoscopic repair of a diaphragmatic laceration. Surg Laparosc Endosc. 1995; 5(5):415-8. View

14.

Gunning K, Moont M, Sugrue M . Laparoscopic repair of penetrating intra-abdominal injuries. Br J Surg. 1995; 82(7):920. DOI: 10.1002/bjs.1800820721. View

15.

Matthews B, Bui H, Harold K, Kercher K, Adrales G, Park A . Laparoscopic repair of traumatic diaphragmatic injuries. Surg Endosc. 2002; 17(2):254-8. DOI: 10.1007/s00464-002-8831-9. View

16.

Khubutiya M, Yartsev P, Guliaev A, Levitsky V, Tlibekova M . Laparoscopy in blunt and penetrating abdominal trauma. Surg Laparosc Endosc Percutan Tech. 2013; 23(6):507-12. DOI: 10.1097/SLE.0b013e3182937c37. View

17.

Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J . Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg. 2007; 77(8):614-20. DOI: 10.1111/j.1445-2197.2007.04173.x. View

18.

Leppaniemi A, Voutilainen P, Haapiainen R . Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg. 1999; 86(1):76-80. DOI: 10.1046/j.1365-2168.1999.00968.x. View

19.

Kong V, Weale R, Blodgett J, Buitendag J, Bruce J, Laing G . Laparotomy for organ evisceration from abdominal stab wounds: A South African experience. Injury. 2018; 50(1):156-159. DOI: 10.1016/j.injury.2018.08.003. View