Are we doing too many non-therapeutic laparotomies in trauma? An analysis of the National Trauma Data Bank
Adeel Ahmed ShamimSuhail ZeineddinAhmad ZeineddinOlubode A. OlufajoGregory MathelierEdward E. CornwellTerrence M. FullumDaniel Tran
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Exploratory laparotomy
Objective: Laparotomy is commonly indicated in patients presenting blunt or penetrating trauma. This cross-sectional study is designed to evaluate the frequency and the causes of laparotomy following abdominal trauma. Materials and Methods: The data of 71 patients who underwent laparotomy as a result of abdominal trauma in Shohada Ashayer Hospital, Khorramabad were evaluated and a questionnaire was completed for each patient. All the data were analyzed statistically using SPSS. Results: Of 71 patients, 61 underwent positive laparotomy whereas, negative laparotomy was performed in 10 patients. The results from this study showed that the most common organ of the injury was spleen (19.7%), followed by other solid organs. The small intestine (16.4%) was found more prone to injuries in penetrating trauma. Incidence of blunt trauma injury due to road accidents was the greatest 50.82% and 20% of penetrating traumas were the result of a firearm. Conclusion: Abdominal trauma injury is common in our study population where spleen, small intestine and other solid organs are chiefly involved. Indications of laparotomy should be fully examined in order to avoid negative laparotomies and associated complications. Keywords: trauma, blunt, laparotomy, penetrating
Exploratory laparotomy
Penetrating Trauma
Blunt trauma
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Abdominal exploration followed by vascular bypass has been the standard of care for acute mesenteric ischemia (AMI), but there is increasing use of endovascular treatment with selective exploratory laparotomy.We performed a retrospective review of patients diagnosed with AMI who underwent mesenteric artery angioplasty or stenting at a single institution from 2010-2017. Patients were divided into 3 groups: those who did not undergo exploratory laparotomy; those who received endovascular treatment before laparotomy (post-reperfusion laparotomy group); and those who had endovascular treatment after laparotomy (pre-reperfusion laparotomy group).Patients who did not undergo exploratory laparotomy showed 85.7% (12/14) survival, compared with 63.6% (7/11) in the post-reperfusion group and 25.0% (2/8) in the pre-reperfusion group, P=0.077). Time to reperfusion was significant (P=0.009) in predicting survival for patients who underwent exploratory laparotomy.Emergent endovascular treatment prior to laparotomy seems to be associated with a higher survival.
Exploratory laparotomy
Mesenteric Ischemia
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Colorectal Surgery
Surgical oncology
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Objective To decrease negative laparotomy in patients suffering from penetrating abdominal wounds. Methods The clinical data of 78 cases of penetrating abdominal wounds undergoing exploratory laparotomy before Jun. 1999 were retrospectively reviewed, and new indication was developed and was applied to 53 cases admitted between Jun. 1999 and Jun. 2000. Results Compared with the 91% of exploratory laparotomy in 78 cases before Jun. 1999, the rate of exploratory laparotomy of penetrating wounds of the abdomen in the 53 cases admitted after Jun. 1999 was 64%. The difference was significant(χ 2=14.51, P 0.01). Conclusions The new indication effectively decreases the negative laparotomy and is clinically applicable.
Exploratory laparotomy
Penetrating Trauma
Penetrating wounds
Acute abdomen
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Exploratory laparotomy
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Colorectal Surgery
Surgical oncology
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Isolated gallbladder rupture following blunt abdominal trauma is rare. Presentation is quite variable and a delayed diagnosis is usually made at exploratory laparotomy. An interesting case is presented which mimicked acute pancreatitis. This case illustrates the need for close observation and a need for a high index of suspicion for intra-abdominal injuries in patients with blunt abdominal trauma.
Exploratory laparotomy
Perforation
Presentation (obstetrics)
Blunt trauma
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Exploratory laparotomy
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The use of selective nonoperative management for anterior abdominal stab wounds has evolved into a readily accepted practice. Multiple reports have shown this strategy to be both safe and effective. However, there is a paucity of long-term studies.A retrospective review was performed of all trauma patients presenting for anterior abdominal stab wounds at a Level I trauma center during a 17-year time period. Primary outcomes were the percentage of patients undergoing an exploratory laparotomy and the negative laparotomy rate.A total of 7,033 patients sustained a stab wound with 1,961 involving the anterior abdomen. The percentage of patients undergoing exploratory laparotomy decreased during the study period from 64.8% to 37.6% (overall 45.8%). The negative laparotomy rate decreased from 21.3% to 8.6% (overall 18.7%). The negative laparotomy rate of patients who underwent exploratory laparotomy immediately did not change over time (13.8%), whereas the negative laparotomy rate of those patients who underwent exploratory laparotomy in a delayed fashion decreased from 25.0% to 6.25%. The overall mortality was 1.9%, with 6.2% mortality for patients undergoing an immediate laparotomy, 0.7% for patients undergoing a delayed laparotomy, and 0.0% for patients managed nonoperatively (p<0.04). The mean length of hospital stay was 6.6 days±0.5 days, with a mean of 9.4 days±0.9 days in patients undergoing an immediate laparotomy, 8.1 days±0.5 days in patients undergo a delayed laparotomy, and 3.8 days±0.2 days in patients managed nonoperatively (p<0.001).Selective nonoperative management for stab wounds to the anterior abdomen is associated with a decreased operative rate and decreased negative laparotomy rate over time. Selective nonoperative management is both safe and effective for anterior abdominal stab wounds.
Stab
Stab wound
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Objective To decrease negative laparotomy in patients suffering from penetrating abdominal wounds. Methods The clinical data of 121 patients of penetrating abdominal wounds undergoing exploratory laparotomy form Jun. 1997 to Oct. 2004 were retrospectively reviewed. Results As absolutely acute indications of patients suffering from penetrating abdominal wounds, the rate of negative laparotomy was 32.2%(39/121). Conclusions None all of the patients suffering from penetrating abdominal wounds need acute operation. The rational acute indications effectively decrease the negative laparotomy
Exploratory laparotomy
Penetrating wounds
Penetrating Trauma
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