Decompressive Laparotomy as a Treatment Option for Refractory Intracranial Hypertension in Patients With Traumatic Brain Injury: A Systematic Review

Abstract

Background: Researchers investigated the role of decompressive laparotomy as a novel technique to improve the outcome of refractory intracranial hypertension in patients with severe Traumatic brain injury (TBI). In this paper, we conduct a systematic review of the literature and discuss the existing information on the role of decompressive laparotomy in patients with severe TBI. Methods: A search for RCT, not RCT, prospective and retrospective cohort studies will be carried out through electronic databases. The strategy comprised topic headings (MeSH) such as "Decompressive laparotomy," "traumatic brain damage," "Neurocritical care," and "intracranial hypertension," as well as text words related to Booleans terms. The following data were retrieved individually and separately: mortality, functional independence (modified Rankin scale 0 to 2, or Glasgow Prognostic Scale with a score of 4 or above), and intracranial pressure value before and after Decompressive laparotomy. Results: Following a thorough text review, ten articles were examined for confidentiality, one of which is a narrative review, two of which did not cover traumatic brain injury and one of which included thoracic and neck trauma, and six of which were included for qualitative and quantitative analysis. Among the six trials considered, 46 patients with TBI and intracranial hypertension were evaluated and treated with hyperosmolar treatment and/or Decompressive Craniectomy with Decompressive laparotomy. The Glasgow Outcome Scale was used to evaluate neurological prognosis and functional competence. Conclusions: According to the findings, 8% of the patients were in a chronic vegetative state, 37.93% had severe disability, 33.45% had moderate disability, and the majority (64.3%) were able to return to work with limitations. The remaining 20.6% had mild disability or good functional recovery.