Outcomes of selective non-operative management in adults with abdominal gunshot wounds: A systematic review and meta-analysis

Abstract

Background and Aims: Abdominal gunshot wounds (GSWs), a clinically devastating injury, can result in a variety of severe and lethal complications. Traditionally, exploratory laparotomy is the first-line approach for the management of abdominal GSWs, but associated with a considerable amount of unnecessary surgeries. At present, selective non-operative management (SNOM) of abdominal GSWs is becoming an effective and well-recognized approach, but remains widely disputed since many surgeons are skeptical about the validity of SNOM in clinical practice. This meta-analysis aims to estimate the outcomes of SNOM and immediate laparotomy in patients with GSWs by collecting the currently available evidence. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched. A random-effects model was employed. Pooled proportion with 95% confidence intervals (CIs) was calculated. Heterogeneity was evaluated using the Cochran’s Q test and I2 statistics. Results: Overall, 53 studies involving 60,291 participants were included. The pooled proportions of SNOM and SNOM failure were 27.0% (95%CI=24.0%-30.0%) and 10.0% (95%CI=7.0%-13.0%), respectively. The pooled mortality after SNOM and SNOM failure were 0.0% (95%CI=0.0%-1.0%) and 0.0% (95%CI=0.0%-0.0%), respectively. The pooled proportions of immediate laparotomy and unnecessary immediate laparotomy were 73.0% (95%CI=70.0%-76.0%) and 10.0% (95%CI=8.0%-13.0%), respectively. The pooled mortality after immediate laparotomy and unnecessary immediate laparotomy were 10.0% (95%CI=8.0%-13.0%) and 0.0% (95%CI=0.0%-1.0%), respectively. Heterogeneity was statistically significant in nearly all meta-analyses. Conclusion: Immediate laparotomy is still the mainstay approach for the management of abdominal GSWs. Approximately one third of patients with abdominal GSWs undergo SNOM. SNOM failure is not frequent and its related mortality is also rare.

Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study

“…Of them, 222 (86.7%) underwent immediate laparotomy, and the remaining 34 (13.3%) were managed via NOM. As a result, NOM may be particularly useful in situations when medical resources are limited, but the amount of trauma is overwhelming [10]. Our result was in line with previous reports.…”

“…[29] and a recent systematic review [3] were 3.5%, 5.7%, and 8.8%, respectively. In a recent systematic review of NOM of abdominal gunshot wounds including 53 studies involving 60,291 participants, the pooled proportions of elective NOM and elective NOM failure were 27% (95% confidence interval (CI): 24%-30%) and 10% (95% CI: 7%-13%), respectively [10]. In contrast, the failure rate of NOM in the study by Bennett et al [5] was higher than our report (14.5%).…”

“…According to a recent systematic review and meta-analysis, urgent laparotomy remains the primary method for managing penetrating abdominal injuries. Approximately one-third of patients with abdominal gunshot wounds get NOM [10].…”