Laparoscopy for hemodynamic stable penetrating abdominal trauma. An exploratory study in a European setting.

Abstract

Abstract Purpose Trauma laparotomy is the golden standard for the treatment of penetrating abdominal trauma, though laparotomy is associated with a higher complication risk and prolonged length of hospital stay. Therefore, we explored whether laparoscopy in a trauma setting can be a valuable alternative. We analyzed the management of hemodynamic stable patients with penetrating abdominal trauma and assessed the applicability of laparoscopy in order to reduce non-therapeutic laparotomies. Methods We performed a retrospective study of hemodynamic stable patients with a penetrating abdominal trauma who underwent surgery. Data were extracted for a 5-year period from January 2018 to December 2022. Collected data included patient demographics, in-hospital data such as radiological procedures, surgical findings and interventions performed and postoperative outcomes with mortality, complication including reoperation, missed injury and length of stay. Results A total of 127 patients were included. We created three groups: A laparoscopy group; a laparoscopy converted to laparotomy group; and a laparotomy group. The e-FAST and CT scan were significantly more positive in the laparotomy group. Most frequently injured organs were liver, diaphragm, stomach, small bowel and colon, retroperitoneal hematoma and spleen. Therapy with hemostatic procedures on the liver and suture of the diaphragm were frequently performed. In total, 29 patients (28%) had a non-therapeutic laparotomy. Conclusion Our study revealed a very high rate of non-therapeutic laparotomies. Considering the organ injuries and surgical procedures performed they can in experienced hands be handled laparoscopically. Prospective studies are urgently needed to assess the safety and efficacy of laparoscopy in abdominal trauma.