A prospective comparison of the selective observation and routine exploration methods for penetrating abdominal stab wounds with organ or omentum evisceration

Soykan Arikan, Ahmet Kocakusak, Ahmet F Yucel, Gokhan Adas
Journal of Trauma 2005, 58 (3): 526-32

BACKGROUND: Both routine laparotomy and selective observation methods have been used in the treatment of penetrating abdominal stab wounds with organ or omentum evisceration. There still are some conflicts about these treatment methods.

METHODS: Between 1998 and 2003, 61 patients treated in the authors' emergency clinic because of penetrating abdominal stab wounds with organ or omentum evisceration were evaluated prospectively. Excepting those with absolute indications for mandatory laparotomy, these patients were treated by either routine laparotomy or selective observation methods. Their prognosis, rates of unnecessary laparotomy, length of hospital stay, and complications were compared using Fisher's exact test and Student's t test.

RESULTS: Nine patients underwent mandatory laparotomy and were therefore excluded from the study. The overall incidence of the patients who had no significant abdominal pathology was 54.1% (33/61). The overall incidence of significant injuries among the asymptomatic patients was 36.5% (19/52). Routine laparotomy was performed for 21 patients, who experienced unnecessary laparotomy and complication rates of 33.33% and 19%, respectively. The mean length of hospital stay in this group was 137.38 +/- 53.25 hours. Of 31 patients, 24 who had been treated by selective observation methods were discharged without laparotomy. The unnecessary laparotomy and complication rates for this group were 6.45% (28.6% for the patients treated surgically) and 3.2%, respectively, whereas the mean length of hospital stay for this group was 81.22 +/- 42.46 hours. There were statistically significant differences in terms of unnecessary laparotomy rates and mean lengths of hospital stay, but no difference in terms of complication rates.

CONCLUSION: The selective observation method is safe and superior to routine laparotomy for the treatment of penetrating abdominal stab wounds with omentum evisceration.

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