Laparoscopy for stable stab wounds: 2.8% conversion, no missed injuries

Design

Retrospective single-centre case series

Population

137 haemodynamically stable patients with abdominal stab wounds explored laparoscopically

Primary outcome

Conversion, missed injury, complications and 30-day mortality

Effect

Conversion 2.8%; missed injuries 0; Clavien-Dindo III to V 8.8%; mortality 0.7%

A retrospective series from a South African trauma unit (Surgical Endoscopy, 6 October) reviewed 170 patients with abdominal stab wounds over 23 months. Ten unstable patients went straight to laparotomy and 19 stable patients were managed without surgery. The remaining 141 stable patients with an indication to explore, such as peritonitis, evisceration or CT findings, had laparoscopy first.

Only 4 of 141 (2.8%) needed conversion. Of 137 completed laparoscopically, 90% had a therapeutic procedure rather than diagnostic inspection alone. There were no missed injuries, major complications (Clavien-Dindo III to V) occurred in 8.8%, and 30-day mortality was 0.7%. Diagnostic cases went home after about a day.

The usual objection to laparoscopy in penetrating trauma is the fear of a missed bowel injury. In a high-volume unit with experienced laparoscopic trauma surgeons this did not happen. The findings support laparoscopy as the first approach for stable patients where that expertise exists; they do not transfer to a unit without it.

• Reserve laparoscopy for haemodynamically stable patients; unstable patients still go to laparotomy.
• Consider laparoscopic exploration for stable stab wounds with peritonitis, evisceration or CT findings where the team has the expertise.
• Run the bowel systematically at laparoscopy and convert early if the view is inadequate.
• Agree a unit threshold for conversion based on surgeon experience and equipment.

Why it matters

Diagnostic laparoscopy spared a laparotomy and its recovery in most stable patients, which matters most where beds are short.

Don't overread it

This is a single high-volume centre's retrospective series without a comparison group; results depend heavily on that team's skill.

The statistics, in plain English

With no comparison group, these are rates in one cohort, not a measured benefit over laparotomy. Zero missed injuries in 137 patients is reassuring but cannot exclude a small risk of a missed injury.

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