Comparative Study between Operative and Conservative Management of Penetrating Anterior Abdominal Stab Injuries

Ahmad Yahia Abdel Dayem; George A. N. Aiad; Hany M. S. Mikhail; Mohammed Elshwadfy; Ahmad Abd Al Aziz

doi:10.3889/oamjms.2022.8783

Authors

Ahmad Yahia Abdel Dayem Department of General and Laparscopic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
George A. N. Aiad Department of General Surgery, Cairo University, Giza, Egypt
Hany M. S. Mikhail Department of Surgery, Cairo University Medical School, Cairo University, Giza, Egypt
Mohammed Elshwadfy Department of General Surgery, Cairo University, Giza, Egypt https://orcid.org/0000-0003-3661-3610
Ahmad Abd Al Aziz Department of General Surgery, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.8783

Keywords:

Penetrating abdominal trauma, Selective non-operative management, Safety and feasibility, Unnecessary laparotomy

Abstract

Background: Presently, non-operative management of penetrating abdominal stab injuries has been standardized in several trauma centers. This strategy has appromising outcome conserving decreasing morbidity.

Aim of the work: This study aimed to assess the safety and feasibility of SNOM of patients having penetrating abdominal stab injuries not indicating emergent laparotomy and to identify a protocol for selection of patient candidates for non-operative management in a tertiary care hospital in Egypt.

Patients & Methods: This is a prospective study that involved patients who presented to the casualty department of Kasr Elainy teaching Hospital, in the period from August 2018 to August 2020, for management of a penetrating abdominal Stab injuries. Fully conscious, haemodynimacally stable patients were included. Eligible patients were allocated to either SNOM group or immediate operative management (IOM) group.

Results: SNOM group included64 patients and IOM group included 40 patients. The age of the patients ranged from 16 to 49 years with a mean of 33±6.8 years, and the majority were males (99%). SNOM failed in 4/69 patients (5.7%) who required delayed laparotomy for peritonitis (2 cases) and HB drop and haemodynamic instability (2 cases). In IOM group, only 3 cases had therapeutic laparotomies (7.3%). The remaining cases had unnecessary laparotomies (92.7%). Statistically significant higher LOS was seen in SNOM group (p<0.05). However, less unnecessary laparotomies and lower incidences of complications were noted (p<0.01).

Conclusion: vital signs together with abdominal examination are the most important clinical criteria in decision making in penetrating abdominal stab injury patients When surgery is not absolutely indicated, SNOM is a safe and feasible approach in management of penetrating abdominal stab injury by following proper management algorithm and selection criteria.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Al Rawahi AN, Al Hinai FA, Boyd JM, Doig CJ, Ball CG, Velmahos GC, et al. Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: A systematic review and meta-analysis. World J Emerg Surg. 2018;13:55. https://doi.org/10.1186/s13017-018-0215-0 PMid:30505340 DOI: https://doi.org/10.1186/s13017-018-0215-0

Bennett S, Amath A, Knight H, Lampron J. Conservative versus operative management in stable patients with penetrating abdominal trauma: The experience of a Canadian level 1 trauma centre. Can J Surg. 2016;59(5):317-21. https://doi.org/10.1503/cjs.015615 PMid:27668329 DOI: https://doi.org/10.1503/cjs.015615

Akkoca M, Balas S, Yilmaz KB, Tatar IG, Akinci M, Tokgoz S, et al. CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma. Asian J Surg. 2019;42(1):148-54. https://doi.org/10.1016/j.asjsur.2018.05.007 PMid:30585169 DOI: https://doi.org/10.1016/j.asjsur.2018.05.007

Goin G, Massalou D, Bege T, Contargyris C, Avaro JP, Pauleau G, et al. Feasibility of selective non-operative management for penetrating abdominal trauma in France. J Visceral Surg. 2017;154(3):167-74. https://doi.org/10.1016/j.jviscsurg.2016.08.006 PMid:27856172 DOI: https://doi.org/10.1016/j.jviscsurg.2016.08.006

Waes OV, Lieshout EV, Silfhout DV, Halm J, Wijffels M, Vledder MV, et al. Selective non-operative management for penetrating abdominal injury in a Dutch trauma centre. Ann R Coll Surg Engl. 2020;102(5):375-82. https://doi.org/10.1308/rcsann.2020.0042 PMid:32233854 DOI: https://doi.org/10.1308/rcsann.2020.0042

Benjamin E, Demetriades D. Nonoperative management of penetrating injuries to the abdomen. Curr Trauma Rep. 2015;1:102-6. DOI: https://doi.org/10.1007/s40719-015-0014-y

Leppäniemi AK, Haapiainen RK. Selective nonoperative management of abdominal stab wounds: Prospective, randomized study. World J Surg. 1996;20(8):1101-5; discussion 1105-1106. https://doi.org/10.1007/s002689900168 PMid:8798372 DOI: https://doi.org/10.1007/s002689900168

Navsaria PH, Nicol AJ, Edu S, Gandhi R, Ball CG. Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study. Ann Surg. 2015;261(4):760-4. https://doi.org/10.1097/SLA.0000000000000879 PMid:25185470 DOI: https://doi.org/10.1097/SLA.0000000000000879

Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, et al. Validating the Western trauma association algorithm for managing patients with anterior abdominal stab wounds: A western trauma association multicenter trial. J Trauma. 2011;71(6):1494-502. PMid:22182859 DOI: https://doi.org/10.1097/TA.0b013e31823ba1de

de Moya M, Goldstein AL. Non-operative management of penetrating abdominal injuries: An update on patient selection. Curr Surg Rep. 2019;7:12. DOI: https://doi.org/10.1007/s40137-019-0234-0

Maurice KK, Elfiky MA, Mashhour SN, Mansour DA, Aiad G, Milad NM. CT tractography in anterior abdominal stab wounds: A proposed algorithm. Eur J Trauma Emerg Surg. 2020;47(5):1553-9. https://doi.org/10.1007/s00068-020-01325-0 PMid:32065243 DOI: https://doi.org/10.1007/s00068-020-01325-0

Osinowo AO, Olusoji OO, Adesanya AA. Abdominal stab wounds in Lagos: A review of fifty cases. Niger Postgrad Med J. 2016;23(2):86-92. https://doi.org/10.4103/1117-1936.186303 Mid:27424619 DOI: https://doi.org/10.4103/1117-1936.186303

Herfatkar MR, Mobayen MR, Karimian M, Rahmanzade F, Gilani S, Baghi I. Serial clinical examinations of 100 patients treated for anterior abdominal wall stab wounds: A cross sectional study. Trauma Mon. 2015;20(4):e24844. https://doi.org/10.5812/traumamon.24844 PMid:26839861 DOI: https://doi.org/10.5812/traumamon.24844

Peponis T, Kasotakis G, Yu J, Alouidor R, Burkott B, Maung AA, et al. Selective nonoperative management of abdominal gunshot wounds from heresy to adoption: A multicenter study of the research consortium of new england centers for trauma (ReCoNECT). J Am Coll Surg. 2017;224(6):1036-45. https://doi.org/10.1016/j.jamcollsurg.2016.12.055 PMid:28259545 DOI: https://doi.org/10.1016/j.jamcollsurg.2016.12.055

Fouda EY, Magdy A, Emile SH. Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning. J Trauma. 2018;20:194-202. DOI: https://doi.org/10.1177/1460408617706389

Paydar S, Salahi R, Izadifard F, Jaafari Z, Abbasi HR, Eshraghian A, et al. Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound. Am J Emerg Med. 2012;30(7):1146-51. https://doi.org/10.1016/j.ajem.2011.08.012 PMid:22100482 DOI: https://doi.org/10.1016/j.ajem.2011.08.012

Schellenberg M, Owattanapanich N, Switzer E, Lewis M, Matsushima K, Lam L, et al. Selective nonoperative management of abdominal shotgun wounds. J Surg Res. 2021;259:79-85. https://doi.org/10.1016/j.jss.2020.10.025 PMid:33279847 DOI: https://doi.org/10.1016/j.jss.2020.10.025