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Evaluation of diagnostic laparoscopy for penetrating abdominal injuries: About 131 anterior abdominal stab wound

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Abstract

Background

The management of hemodynamically stable patients with anterior abdominal stab wounds (AASW) is debated. Mini-invasive techniques using laparoscopy and non-operative management (NOM) have reduced the rate of nontherapeutic laparotomies after AASW leading to unnecessary morbidity. The aim of this study was to determine with a systematic diagnostic laparoscopy of peritoneal penetration (PP), patients who do not require abdominal exploration in the management of stable patient with an AASW.

Methods

All patients with AASW were retrospectively recorded from 2006 to 2018. Criteria of inclusion were AASW patients who underwent a systematic diagnostic laparoscopy. Criteria of exclusion were patients with an evisceration, impaling, clinical peritonitis, and hemodynamic instability. If no PP was detected, laparoscopy was terminated. If defects of peritoneum were found, a laparotomy was performed looking for diagnosis and treatment of intra-abdominal injuries.

Results

On 131 AASW patients, 35 underwent immediate emergency laparotomy, 96 underwent diagnostic laparoscopy, 47 were positive (PP) and had an intra-abdominal exploration by laparotomy, 32 (68.1%) had intra-abdominal injuries which required treatment. All patients with an intra-abdominal injury had a positive diagnostic laparoscopy. For the 49 patients with a negative laparoscopy, the mean hospital stay was 1.6 days with ambulatory care for some patients. No patient presented a delayed injury. Non-therapeutic laparotomy rate was 15.6%. For patients who did not have an intra-abdominal injury the morbidity rate was low (3%).

Conclusion

Our study shows that diagnostic laparoscopy was safe, with a low duration of hospitalization, a possible ambulatory care and had an excellent ability to screen the patients who did not need a abdominal exploration. This management can avoid many unnecessary laparotomies with an acceptable rate of negative laparotomy, without any delayed diagnosis of intra-abdominal injuries and with a low morbidity rate.

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Acknowledgements

Thanks to Romain Isenbart and Alexandre Gerardin for their contribution.

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Authors and Affiliations

  1. Department of Digestive, Endocrine and Metabolic Surgery, Hôpital Robert Schuman – Groupe Hospitalier UNEOS, Rue du Champ Montoy, 57070, Metz, France

    Cyrille Buisset

  2. Department of Urology, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, France

    Charles Mazeaud

  3. Department of Gastrointestinal, Metabolic and Surgical Oncology, University Hospital Nancy Brabois, Rue du Morvan, 54511, Vandoeuvre-Les-Nancy, France

    Agathe Postillon, Claire Nominé-Criqui, Thibaut Fouquet, Nicolas Reibel, Laurent Brunaud & Manuela Perez

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  1. Cyrille Buisset
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  2. Charles Mazeaud
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  8. Manuela Perez
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Correspondence to Cyrille Buisset.

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Disclosures

Cyrille Buisset, Charles Mazeaud, Agathe Postillon, Claire Nominé-Criqui, Thibaut Fouquet, Nicolas Reibel, Laurent Brunaud and Manuela Perez have no conflicts of interest or financial ties to disclose.

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Buisset, C., Mazeaud, C., Postillon, A. et al. Evaluation of diagnostic laparoscopy for penetrating abdominal injuries: About 131 anterior abdominal stab wound. Surg Endosc 36, 2801–2808 (2022). https://doi.org/10.1007/s00464-021-08566-z

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  • DOI: https://doi.org/10.1007/s00464-021-08566-z

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