Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: A systematic review and meta-analysis

Hajibandeh, Shahin; Hajibandeh, Shahab; Gumber, Ashutosh; Wong, Chee Siong

doi:10.1016/j.ijsu.2016.08.524

Cited by 78 publications

(67 citation statements)

References 22 publications

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“…As familiarity with the technique of laparoscopy improved, so too did its sensitivity . A recent systematic review and meta‐analysis described a rate of missed injury of 118/1604 patients (7.4%), with all missed injuries being reported in studies published prior to 2010 . The majority of included studies reported a 100% sensitivity for ruling out abdominal visceral injury .…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta‐analysis described a rate of missed injury of 118/1604 patients (7.4%), with all missed injuries being reported in studies published prior to 2010 . The majority of included studies reported a 100% sensitivity for ruling out abdominal visceral injury . Diagnostic laparoscopy was reported to avoid non‐therapeutic laparotomy in 45.6% of patients …”

Section: Discussionmentioning

confidence: 99%

“…The majority of included studies reported a 100% sensitivity for ruling out abdominal visceral injury . Diagnostic laparoscopy was reported to avoid non‐therapeutic laparotomy in 45.6% of patients …”

Section: Discussionmentioning

confidence: 99%

“…The 2010 EAST guidelines for the management of penetrating abdominal trauma do not recommend local wound exploration or serial observation without concurrent CT scan, while acknowledging the potential limitations of CT including the specific risk of missed diaphragmatic and small bowel injury . Exploratory laparotomy can be considered the gold standard investigation in the management of penetrating abdominal trauma, but may be associated with a high rate of negative laparotomy (up to 61%) …”

Section: Introductionmentioning

confidence: 99%

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Diagnostic laparoscopy in penetrating abdominal trauma

Cocco

Bhagvan

Bouffler

et al. 2019

ANZ Journal of Surgery

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Background: Penetrating abdominal trauma is uncommon in Australia. There are multiple potential approaches to the patient without an indication for immediate laparotomy. This study examined the management of patients with a penetrating anterior abdominal injury in a Level 1 trauma centre, and in particular investigated the outcomes of those patients who underwent diagnostic laparoscopy. Methods: A retrospective review was undertaken of all patients presenting to a Level 1 trauma centre with an anterior abdominal stab wound over a 15-year period. Patient demographic, injury, examination, treatment and outcome data were extracted. These data were analysed using SPSS PASW version 20. Results: A total of 318 patients were identified. Immediate laparotomy was performed in 121 of those patients. Of the remaining 197 patients, 146 underwent diagnostic laparoscopy. Peritoneal breach was identified in 87 patients, 79 of whom then had exploratory laparotomy. The laparotomy was therapeutic in 36 of 79 patients (45.6%). Multiple stab wounds were an independent predictor of therapeutic laparotomy (hazard ratio 2.39, 95% CI 1.16-4.93). Diagnostic laparoscopy was 100% sensitive, 60.9% specific and had a negative predictive value of 100% and a positive predictive value of 40%. Non-therapeutic laparotomy was associated with a median length of stay of 5.5 days and a complication rate of 9.3%. Conclusion: Diagnostic laparoscopy to detect peritoneal breach is a safe approach in the management of anterior abdominal stab wounds. However, utilizing peritoneal breach as an indication for laparotomy is associated with a moderate incidence of non-therapeutic laparotomy. Measures to decrease the negative laparotomy rate should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic laparoscopy in penetrating abdominal trauma

Cocco

Bhagvan

Bouffler

et al. 2019

ANZ Journal of Surgery

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“…In the 1960s, Shaftan first challenged the idea of mandated laparotomies for abdominal trauma with his term of selective conservatism, as half of his patients with penetrating abdominal trauma did not require operative repair [2]. In recent review, surgical exploration in the setting of penetrating abdominal trauma has been associated with negative laparotomy rates of about 61% [3]. Negative or non-therapeutic laparotomies are associated with 20% morbidity rate [4].…”

Section: Introductionmentioning

confidence: 99%

Role of Laparoscopy in Abdominal Trauma

Wafa¹,

Mustafa²,

Rawad³

et al. 2019

Int J Surg Res Pract

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Background: The role of laparoscopy in abdominal trauma has increased in the last years in diagnosis as well as therapeutic interventions. It is a viable alternative for the diagnosis of intra-abdominal injury in both penetrating and blunt trauma. The number of negative laparotomies decreased since the use of laparoscopy in trauma patients. Methods: A retrospective study of twenty eight patients with abdominal trauma (22 penetrating trauma, 6 blunt trauma) were laparoscopic intervention done by general surgery department at Aljazeera Hospital for Orthopedic and Specialized Surgery from January 2017 to March 2019. All patients underwent clinical assessment and FAST-Scan, CT-scan done for twenty patients and unavailable for eight patients. All of the patients included for the research were stable with normal blood pressure. Results: In our series twenty-eight patients with abdominal trauma, 22 penetrating trauma (78.57%) all were shotgun injuries, and 6 blunt trauma (21.43%). In penetrating trauma therapeutic laparoscopy for seven patients (31.8%), diagnostic laparoscopy for 10 patients (45.5%), and negative laparoscopy for 5 cases (22.7%). In blunt trauma therapeutic laparoscopy for 2 cases (33.3%), diagnostic laparoscopy for 3 cases (50%), and negative laparoscopy for 1 case (16.7%). The rate of conversion to laparotomies was 8 cases (28.5%) for both penetrating and blunt trauma. Conclusion: Laparoscopy can be safely performed in hemodynamically stable patients with abdominal trauma for both diagnostic and therapeutic purposes; also it helps to cut down the number of non-therapeutic laparotomies.

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Laparoscopy has better performance than laparotomy in the treatment of stable penetrating abdominal trauma: A retrospective cross‐sectional study in a trauma referral hospital in Colombia

Gómez

Vargas

Lozada-Martínez

et al. 2022

Health Science Reports

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Background: Abdominal trauma is one of the leading causes of death. In Colombia, few studies have evaluated the results on related factors and outcomes when comparing laparotomy versus laparoscopy in the management of penetrating abdominal trauma. Therefore, the aim of this study was to investigate the feasibility and safety of laparoscopy in the treatment of stable penetrating abdominal trauma in a limited resources environment in a middle-income country.Methods: Retrospective cross-sectional study was conducted in Bogota, Colombia from January 2018 to October 2020. Patients over 18 years old, hemodynamically stable with penetrating abdominal trauma without other body parts injuries, that underwent laparoscopy and/or laparotomy surgical exploration and treatment were included. Frequencies, percentages, correlations, and odds ratio were calculated.Results: A total of 52 patients were analyzed (26 laparoscopy vs. 26 laparotomy).Stabbing injuries were more frequent in both groups (76.9%), as well as involvement of the anterior abdomen. None missed enterotomies were reported in the laparoscopy group. Surgical time and bleeding were significantly lower in the laparoscopic approach group (63 vs. 115 min and 65 vs. 992 cc, respectively).The time to oral intake and length of stay in the intensive care unit was significantly shorter in the laparoscopic management group (2 vs. 3 days and 1 vs. 4 days, respectively).Conclusions: Surgical results found a safe scenario in a limited resources environment for the application of the laparoscopic technique to approach penetrating abdominal trauma in stable patients without missed injuries, low threshold of conversion to open approach, and additionally not presenting a higher percentage of complications compared with the laparotomy group in Colombia.

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Laparoscopy versus laparotomy for the management of penetrating abdominal trauma: A systematic review and meta-analysis

Cited by 78 publications

References 22 publications

Diagnostic laparoscopy in penetrating abdominal trauma

Diagnostic laparoscopy in penetrating abdominal trauma

Role of Laparoscopy in Abdominal Trauma

Laparoscopy has better performance than laparotomy in the treatment of stable penetrating abdominal trauma: A retrospective cross‐sectional study in a trauma referral hospital in Colombia

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