Muhammad Iqbal, Qamaruddin Baloch, Anees-uz Zaman, Farhan Zaheer, Imrana Aziz, Arshad Arain.
Non therapeutic Laparotomies in Penetrating Abdominal Trauma patients: Time to Change the Trend.
J Surg Pak Nov ;20(1):23-7.

Objective: To determine the frequency of non therapeutic laparotomies in penetrating abdominal trauma patients, their relation with the diagnostic procedures and hemodynamic status of patients and the final outcome in terms of morbidity and mortality. Study design: Case series. Place & Duration of study: A & E Department of Dow University of Health Sciences and Civil Hospital Karachi, from January 2011 to June 2014. Methodology: Patients with penetrating abdominal injuries who presented to Accident and Emergency Department and underwent exploratory laparotomy were included in the study. Laparotomies were labeled as therapeutic if intra-abdominal injuries required surgical intervention and repair done, while laparotomies with injuries that did not require surgical intervention i.e, serosal tear, non expanding retroperitoneal, mesenteric and visceral hematoma were labeled as non therapeutic. Patient’s vital instability and investigations directed to find out intra-peritoneal visceral injuries and local wound exploration findings were recorded along with the outcome in terms of morbidity and mortality. Results: A total of 115 patients with penetrating abdominal injuries were included. Majority (n=109- 94.8%) of the patients were young males. Most common cause of panetrating injury was firearm (n=106 92.2%). Non therapeutic explorations were done in 23 (20%) patients. The major causes of non-therapeutic explorations were vital instability due to associated injuries (34.7%) and peritoneal breach confirmation on local wound exploration (n=12 - 52.17%). One patient who underwent non therapeutic laparotomy along with thoracotomy due to associated chest injury died on table. One patient developed wound infection and other developed respiratory infection. Average hospital stay was 8.1 days. Conclusions: The study highlighted the need of selective nonoperative approach for the clinically stable patients with penetrating abdominal trauma. With the use of CT scan abdomen or diagnostic laparoscopy along with repetitive clinical examination the frequency of nontherapeutic explorations can be minimized.

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