Surgical treatment of abdominal stab wounds: A retrospective evaluation of 100 cases in a low- incidence environment

Abstract

Abstract Purpose Abdominal stab wounds (ASW) represent a rare subclass of trauma in Europe and might therefore cause uncertainty in choosing the adequate therapeutic approach. Therefore, the aims of this retrospective study were (1) to investigate patient outcome with regard to the treatment method and (2) to develop a diagnostic and therapeutic algorithm for laparoscopic surgery. Methods 100 cases of (thoraco-) abdominal stab wounds (T/ASW)were identified from 2003 to 2019. A review of the medical records identified injury patterns, Injury Severity Score, diagnostic approaches, therapy, morbidity and mortality, length of treatment, and patient outcomes. Results T/ASW occurred in 53 cases due to violent crime, in 11 cases due to accidents and in 36 cases with suicidal intent. Gender distribution was 82 male, 18 female, and the average age was 41 years. The majority (n = 65) of these patients were admitted to our center via the trauma unit. 33 patients received local wound exploration and were admitted to the hospital for observation. Two of these patients deteriorated during the observation period and were admitted to the OR. Laparoscopy was performed in 27 cases, with 6 conversions to laparotomy. 39 patients underwent primary laparotomy. Overall, complications requiring further intervention occurred in six cases. Four patients died; three patients died postoperatively, and one patient died in the trauma bay. The length of hospital stay was significantly shorter int patients undergoing laparoscopic treatment than in patients receiving laparotomy. Conclusion The decision for surgical exploration of ASW should be made generously. Primary laparoscopic exploration is recommended in stable patients. For critically injured patients, laparotomy remains the gold standard.