Role of Laparoscopy in Patients with Penetrating Abdominal Shotgun Injuries

Objective: This work tries to put a clear management plan for patients with penetrating abdominal shotgun injuries and to demonstrate the advantages of laparoscopy if exploration is decided. Background: Shotgun injuries present specific challenges for the surgeon. Multiple penetrating wounds frequently involve large anatomic areas with potential multi-system injury. Methods: The study was conducted on 40 patients presented to Kasr Al-Ainy Medical school with penetrating abdominalshotguninjuries, who were randomlyallocatedinto two groups, Group (1): Patients were treated conservatively for 72 hours and Group 2: The patients were explored either by open technique or by laparoscope (the main domain of this study). Results: In Group (2), 4 patients had laparoscopic explorations, 3 were negative and one patient had intestinal injury so converted to open procedure. 14 patients had open explorations and the rate of wound complications was more in the open group. Collectively, in Group 2, it was found that most of the patients (13 out of 18 which is 72.2%) had negative ornon-significant injuries and only 5 out of 18 patients (27.8%) showed significant injuries which demanded repair. So, most of open explorations was done with no benefit but on thecontrary they had the chance of developing complications of abdominal explorationsso laparoscopy gave added value for patients because they avoided the morbidity of lengthy exploratory wound and also because the rate of negative exploration is very high. Conclusion: When exploration is decided in patients with penetrating abdominal shotgun injuries either in the first assessment of the patient or later during conservative management, laparoscopy gives added value for these patients avoiding the morbidity of lengthy exploratory wound especially that the rate of negative or non-significant injuries is very high. Although the main draw back is the small number of the study group.