Laparoscopy for stable penetrating abdominal trauma

INTRODUCTION: Trauma laparotomy remains the gold standard for treating penetrating abdominal trauma, but it carries a higher risk of complications and longer hospital stays than other approaches. We explored whether laparoscopy could serve as a valuable alternative in the trauma setting. This study analysed the management of haemodynamically stable patients with penetrating abdominal trauma to assess the applicability of laparoscopy and its potential to reduce non-therapeutic laparotomies. METHODS: We conducted a retrospective study of haemodynamically stable patients with penetrating abdominal trauma who underwent surgery. Data were collected over a five-year period (January 2018-December 2022), including demographics, radiological procedures, surgical findings and interventions, and post-operative outcomes: mortality, complications (including reoperation and missed injury) and length of stay. RESULTS: A total of 127 patients were included and divided into three groups: laparoscopy, laparoscopy converted to laparotomy and laparotomy. Extended focused assessment with sonography in trauma E-FAST and computed tomography were significantly more often positive in the laparotomy group than in the other groups. Commonly injured organs included the liver, diaphragm, stomach, small bowel, colon, retroperitoneum and spleen. Frequent interventions were liver haemostasis and diaphragm repair. In total, 29 patients (28%) underwent non-therapeutic laparotomy. CONCLUSIONS: We found a high rate of non-therapeutic laparotomies. Given the injuries and procedures, laparoscopy appears feasible in experienced hands. Prospective studies are urgently needed to assess its safety and efficacy in abdominal trauma. FUNDING: None. TRIAL REGISTRATION: Not relevant.