Top

Surgical Endoscopy

Published in:

14-10-2023 | Laparoscopy

Role of laparoscopy in management of patients with anterior abdominal stab wounds

Authors: Chien Wu, Keng-Li Lin, Yin-Jen Chang, Heng-Fu Lin

Published in: Surgical Endoscopy | Issue 12/2023

Abstract

Background

In this retrospective cohort study, we assessed the utility of laparoscopic surgery for diagnostic and therapeutic purposes in patients with anterior abdominal stab wounds (AASWs). We also investigated patient characteristics that might suggest a greater suitability of laparoscopic interventions.

Methods

Over a 25-year span, we analyzed AASW patients who had operations, categorizing them based on the presence of significant intra-abdominal injuries and whether they received laparoscopic surgery or laparotomy. We compared variables such as preoperative conditions, surgical details, and postoperative outcomes. We further evaluated the criteria indicating the necessity of direct laparotomies and traits linked to overlooked injuries in laparoscopic surgeries.

Results

Of 142 AASWs surgical patients, laparoscopic surgery was conducted on 89 (62.7%) patients. Only 2 (2.2%) had overlooked injuries after the procedure. Among patients without significant injuries, those receiving laparoscopic surgery had less blood loss than those receiving laparotomy (30.0 vs. 150.0 ml, p = 0.004). Patients who underwent laparoscopic surgery also had shorter hospital stays (significant injuries: 6.0 vs. 11.0 days, p < 0.001; no significant injuries: 5.0 vs. 6.5 days, p = 0.014). Surgical complications and overlooked injury rates were comparable between both surgical methods. Bowel evisceration correlated with higher laparotomy odds (odds ratio = 16.224, p < 0.001), while omental evisceration did not (p = 0.107).

Conclusions

Laparoscopy is a safe and effective method for patients with AASWs, fulfilling both diagnostic and therapeutic needs. For stable AASW patients, laparoscopy could be the preferred method, reducing superfluous nontherapeutic laparotomies.

Plackett TP, Fleurat J, Putty B, Demetriades D, Plurad D (2011) Selective nonoperative management of anterior abdominal stab wounds: 1992–2008. J Trauma 70:408–413 (discussion 413–404)

Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 205:129–132CrossRefPubMedPubMedCentral

Moore EE, Marx JA (1985) Penetrating abdominal wounds. Rationale for exploratory laparotomy. JAMA 253:2705–2708CrossRefPubMed

Paydar S, Salahi R, Izadifard F, Jaafari Z, Abbasi HR, Eshraghian A, Hosseini SV, Farrokhnia F, Golshan Y, Bolandparvaz S (2012) Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound. Am J Emerg Med 30:1146–1151CrossRefPubMed

Omari A, Bani-Yaseen M, Khammash M, Qasaimeh G, Eqab F, Jaddou H (2013) Patterns of anterior abdominal stab wounds and their management at Princess Basma Teaching Hospital, North of Jordan. World J Surg 37:1162–1168CrossRefPubMed

Leppäniemi A, Salo J, Haapiainen R (1995) Complications of negative laparotomy for truncal stab wounds. J Trauma 38:54–58CrossRefPubMed

Weigelt JA, Kingman RG (1988) Complications of negative laparotomy for trauma. Am J Surg 156:544–547CrossRefPubMed

Morrison JE, Wisner DH, Bodai BI (1996) Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization. J Trauma 41:509–513CrossRefPubMed

Buisset C, Mazeaud C, Postillon A, Nominé-Criqui C, Fouquet T, Reibel N, Brunaud L, Perez M (2022) Evaluation of diagnostic laparoscopy for penetrating abdominal injuries: about 131 anterior abdominal stab wound. Surg Endosc 36:2801–2808CrossRefPubMed

10.

Zantut LF, Ivatury RR, Smith RS, Kawahara NT, Porter JM, Fry WR, Poggetti R, Birolini D, Organ CH Jr (1997) Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 42:825–829 (discussion 829–831)CrossRefPubMed

11.

O’Malley E, Boyle E, O’Callaghan A, Coffey JC, Walsh SR (2013) Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg 37:113–122CrossRefPubMed

12.

Lin HF, Wu JM, Tu CC, Chen HA, Shih HC (2010) Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg 34:1653–1662CrossRefPubMed

13.

Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, Haan JM, Jurkovich GJ, Harrison P, Moore FO, Schreiber M, Knudson MM, Moore EE (2009) Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 66:1294–1301

14.

Bain K, Meytes V, Chang GC, Timoney MF (2019) Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Surg Endosc 33:1618–1625CrossRefPubMed

15.

Marks JM, Ramey RL, Baringer DC, Aszodi A, Ponsky JL (1995) Laparoscopic repair of a diaphragmatic laceration. Surg Laparosc Endosc 5:415–418PubMed

16.

Gunning KA, Moont M, Sugrue M (1995) Laparoscopic repair of penetrating intra-abdominal injuries. Br J Surg 82:920CrossRefPubMed

17.

Matthews BD, Bui H, Harold KL, Kercher KW, Adrales G, Park A, Sing RF, Heniford BT (2003) Laparoscopic repair of traumatic diaphragmatic injuries. Surg Endosc 17:254–258CrossRefPubMed

18.

Khubutiya M, Yartsev PA, Guliaev AA, Levitsky VD, Tlibekova MA (2013) Laparoscopy in blunt and penetrating abdominal trauma. Surg Laparosc Endosc Percutan Tech 23:507–512CrossRefPubMed

19.

Chestovich PJ, Browder TD, Morrissey SL, Fraser DR, Ingalls NK, Fildes JJ (2015) Minimally invasive is maximally effective: diagnostic and therapeutic laparoscopy for penetrating abdominal injuries. J Trauma Acute Care Surg 78:1076–1083 (discussion 1083–1075)CrossRef

20.

Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J (2007) Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg 77:614–620CrossRefPubMed

21.

Leppäniemi AK, Voutilainen PE, Haapiainen RK (1999) Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg 86:76–80CrossRefPubMed

22.

American College of Surgeons, Committee on Trauma (2018) Advanced Trauma Life Support (ATLS®) student course manual, 10th edn. American College of Surgeons, Chicago

23.

Kong VY, Weale R, Blodgett JM, Buitendag J, Bruce JL, Laing GL, Clarke DL (2019) Laparotomy for organ evisceration from abdominal stab wounds: a South African experience. Injury 50:156–159CrossRefPubMed

Title: Role of laparoscopy in management of patients with anterior abdominal stab wounds
Authors: Chien Wu
Keng-Li Lin
Yin-Jen Chang
Heng-Fu Lin
Publication date: 14-10-2023
Publisher: Springer US
Keywords: Laparoscopy
Laparotomy
Laparotomy
Published in: Surgical Endoscopy / Issue 12/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10487-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Role of laparoscopy in management of patients with anterior abdominal stab wounds

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2023

Mesh overlap for ventral hernia repair in current practice

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Selection of surgical modality for massive splenomegaly in children

Safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for benign retroperitoneal tumors: a retrospective cohort study

Laparoscopic anatomical left hemihepatectomy guided by middle hepatic vein in the treatment of left hepatolithiasis with a history of upper abdominal surgery

Decision regret up to 6 years after sleeve gastrectomy