Laparoscopy Vs Open Study for Abdominal Injuries

Background: Abdominal injuries, resulting from both blunt and penetrating mechanisms, constitute a major source of emergency surgical admissions and critical morbidity globally. While conventional exploratory laparotomy has long served as the standard diagnostic and therapeutic approach, it is frequently limited by high rates of non-therapeutic laparotomies (NTL) and notable wound-related or pulmonary complications. Diagnostic and therapeutic laparoscopy has evolved as a minimally invasive alternative aimed at mitigating these interventions. This study presents a prospective observational evaluation of clinical outcomes, operative metrics, and postoperative complication profiles between laparoscopic evaluation and open exploration for abdominal trauma managed at a single tertiary care center. Material and Methods: A prospective observational study was conducted on 30 adult patients presenting with blunt or penetrating abdominal trauma who were hemodynamically stable and required surgical evaluation. Patients were partitioned into two cohorts based on the executed surgical approach determined by injury characteristics and clinical protocol parameters (hemodynamically stable patients with a negative or equivocal Focused Assessment with Sonography for Trauma (FAST) or CT scan suspected of isolated peritoneal violation/diaphragmatic injury were planned for laparoscopic evaluation, while patients presenting with immediate evisceration, severe haemorrhage, peritonitis, or macroscopic bowel perforation on imaging were managed via open laparotomy): Laparoscopic Trauma Evaluation/Repair (n = 18) and Open Exploratory Laparotomy (n = 12). Intraoperative parameters (measured from skin incision to skin closure), postoperative complications, length of hospital stay, and rates of missed injury or negative exploration were tracked. Statistical evaluation utilised Student's t-test for continuous metrics and Fisher's exact test for categorical proportions. Results: The study population (N = 30) exhibited a mean age of 32±9 years with a definitive male predominance (21 males, 9 females). The baseline presentation consisted of 16 blunt abdominal injuries (53.3%) and 14 penetrating injuries (46.7%), with stab wounds representing the majority of penetrating mechanisms. Laparoscopic management demonstrated a statistically significant reduction in mean operative duration compared to the open laparotomy cohort. Furthermore, the laparoscopic approach significantly decreased the mean postoperative hospital stay to 2-4 days compared to 8-10 days in the open surgery. The overall complication incidence across the study was 26.7% (n = 8). Strikingly, the laparoscopic group experienced only 1 complication (1/18, 5.6%), which manifested as a localized port-site infection. Conversely, 7 complications occurred within the open laparotomy cohort (7/12, 58.3%), representing a statistically lower early localized and systemic morbidity profile for the laparoscopic arm (p = 0.002). At the conclusion of the follow-up period, there were zero missed injuries (0%) or delayed presentations across either surgical cohort. Conclusion: Laparoscopic evaluation and repair for abdominal trauma represents a safe, highly effective, and clinically superior alternative to conventional exploratory laparotomy in hemodynamically stable patients. It provides statistically sound advantages by substantially decreasing skin-to-skin operative duration, reducing the post-surgical hospital footprint, minimising non-therapeutic laparotomies, and significantly reducing wound-related morbidity.

Keywords: Abdominal Trauma, Blunt Injury, Penetrating Trauma, Laparotomy, Diagnostic Laparoscopy, Non-Therapeutic Laparotomy, Wound Infection, Trauma Management.