The impact of practical implementation of non operative management of penetrating abdominal trauma

Abstract

laparotomy (EL) is still the standard of care in penetrating abdominal trauma (PAT). Purpose: To assess the incidence of major injuries in PAT, the need of surgical resolution, and a comparative evaluation of EL and SCA management in this kind of trauma. Materials and methods: A 4-year retrospective review of patients sustaining a penetrating abdominal trauma hospitalized in Chisinau Emergency Hospital was performed. There were used the following approaches: SCA – in 37 patients, EL – 74, and in 11 cases the laparotomy was avoided by the use of a diagnostic laparoscopy. Rate of non-therapeutic laparotomies, complications, hospital stays and hospital charges were analyzed. Discussion results: There were 122 patients with penetrating abdominal wounds. Fifty one (41.8%) patients had not any major intra-abdominal injury. In SCA group: there were 3(8.1%) cases of failed approach and 34(91.9%) patients were successfully managed without laparotomy. Patients successfully managed by SCA (34 cases) had significantly shorter hospital stay than those who underwent non-therapeutic laparotomy (3 patients), 2,94±0,37 vs 8,0±2,47 days, hospital charges 868,0±200,1 vs 2466,5±753,5 lei, and morbidity (p<0.05). Despite of longer preoperative time in failed SCA group, 660±60 vs 90,05±7,22 minutes (p<0.001), compared to the therapeutic laparotomy of EL group, they had better outcomes such as: hospital stay, 6 vs 10,51±1,09 days (p<0.001) and hospital charges 2105,5±542,1 vs 4109±638,49 lei (p<0.05).Conclusion: The incidence of major injuries in patients with penetrating abdominal trauma does not exceed 58%, which determine the necessity to avoid the unnecessary laparotomy in 42% of cases. In patients with penetrating wounds without major injuries, the implementation of non-operative management is beneficial by: avoiding of non-therapeutic laparotomies, shortened hospital stays, reducing of complications and costs with negligible morbidity and null mortality rates. In patients with major injuries the non-operative management carries a risk of 8.1 % of delayed laparotomy, but it does not carry morbidity or additional charges.