Laparoscopy as the initial approach for hemodynamically stable abdominal stab wounds requiring exploration: a South African single-center experience.

Abstract

Background: The role of laparoscopy in penetrating abdominal trauma remains debated, and its adoption varies widely, largely due to concerns regarding missed injuries and the need for advanced laparoscopic expertise. We report our single-center experience using laparoscopy for hemodynamically stable patients with abdominal-region stab wounds with an indication for operative exploration (peritonitis, evisceration, or CT findings).

Methods: We performed a retrospective analysis of data from a single-center trauma unit over a 23-month period. Patients with abdominal-region stab wounds meeting operative criteria and managed with laparoscopic exploration were included.

Results: Of 170 patients with abdominal stab wounds, 10 (5.9%) were hemodynamically unstable and underwent immediate laparotomy. Of the remaining 160 stable patients, 19 (11.9%) were successfully managed non-operatively. Laparoscopic exploration was performed in 141 patients; 4/141 (2.8%) required conversion to laparotomy. The final laparoscopic cohort comprised 137 patients. The mean ISS was 10.1 (range 9-18). Diagnostic laparoscopy was performed in 14 patients (10.2%), and therapeutic laparoscopy in 123 (89.8%). Mean length of stay was one day (range 1-2) for diagnostic and 4.6 days (range 1-20) for therapeutic laparoscopy. There were no missed injuries. Complications (Clavien-Dindo III-V) occurred in 8.8% of patients, and 30-day mortality was 0.7%.

Conclusion: Laparoscopy is feasible for hemodynamically stable patients with abdominal-region stab wounds who require surgical exploration, with favorable outcomes in this series. Laparoscopy should be considered the initial operative approach in centers with appropriate expertise and resources. The range of therapeutic interventions and the threshold for conversion to laparotomy should be individualized based on the surgeon's experience, institutional capabilities, and equipment availability.