The role of laparoscopy in management of stable patients with penetrating abdominal trauma and organ evisceration

Oleh Y Matsevych, Modise Z Koto, Sooraj R Motilall, Neha Kumar
Journal of Trauma and Acute Care Surgery 2016, 81 (2): 307-11

BACKGROUND: Organ evisceration after penetrating abdominal trauma (PAT) carries a high rate of significant intra-abdominal injuries. There is uniform agreement that organ evisceration warrants immediate laparotomy. Nonoperative management of stable asymptomatic patients with evisceration is associated with a high failure rate. Most authors exclude patients with organ evisceration from laparoscopic management.The aims of this study were to determine the significance of organ evisceration in stable patients with PAT and to assess the feasibility of laparoscopic management of this group.

MATERIALS AND METHODS: Intraoperative findings, performed surgery, and complications in stable patients who underwent laparoscopy for PAT and evisceration between January 2012 and December 2014 were retrospectively analyzed. All unstable patients underwent laparotomy and were excluded.

RESULTS: A total of 189 stable patients were treated with laparoscopy for PAT. Thirty-nine patients (20.6%) had organ evisceration; 37 patients had stab wounds and 2 patients had gunshot wounds. Fifteen patients had bowel evisceration and 24 had omental evisceration. In total, 25 patients (64%) had significant injuries (colon, small bowel, etc.) and required therapeutic laparoscopy. The rate of therapeutic laparoscopy was 73% in patients with bowel evisceration and 58% in patients with omental evisceration. This difference was not statistically significant. The most commonly injured organ was the small bowel. The small-bowel repair, resection, and anastomosis were the most commonly performed procedures. We did not have any missed injuries. There were neither conversions nor significant complications in the postoperative period. Fourteen patients avoided nontherapeutic laparotomy.

CONCLUSION: Organ evisceration in stable patients with PAT is associated with a high rate of significant intra-abdominal injuries and mandates abdominal exploration. Laparoscopic management is feasible, has a high accuracy in identifying intra-abdominal injuries, provides all benefits of minimal invasive surgery, and avoids nontherapeutic laparotomy.

LEVEL OF EVIDENCE: Therapeutic study, level V.

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