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

Background: Organ evisceration following penetrating abdominal trauma (PAT) carries a high rate of significant intraabdominal 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 aim of this study was to determine the significance of organ evisceration in stable patients with PAT and to assess the feasibility of laparoscopic management of this group. Material 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 (20.6%) patients had organ evisceration; 37 were due to stab and two patients due to gunshot wounds. Fifteen patients had bowel evisceration and 24 had omental evisceration. In total 25 (64%) patients 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 intraabdominal injuries and mandates abdominal exploration. Laparoscopic management is feasible, has a high accuracy in identifying intraabdominal injuries, provides all benefits of minimal invasive surgery and avoids nontherapeutic laparotomy. Level of evidence: V Study type: Therapeutic, Diagnostic test (C) 2016 Lippincott Williams & Wilkins, Inc.

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