Comparison between Open and Laparoscopic Formal Abdominal Exploration in Penetrating Anterior and Thoraco-Abdominal Stab Wounds

Background: The management of patients with anterior and thoraco-abdominal stab wounds has been debated for many years. Although laparotomy is mandatory in patients presenting with shock, evisceration and peritonitis, Controversies still exist regarding the best approach for patients without these presentations. Laparoscopic surgery plays an important role regarding the diagnosis and management of this group of patients.Aim of the Study: This study was conducted to compare the results regarding the open and laparoscopic formal abdominal exploration in penetrating anterior and thoraco-abdominal stab wounds.Patients: This prospective randomized controlled study included 50 vitally stable patients who presented to Kasr Al-Ainy Emergency Department with anterior and thoraco-abdominal stab wounds during the period from March 2014 to June 2015.Methods: All patients were subjected to screening laparoscopy. Those who were proven to be non-penetrating were excluded. Patients with proven peritoneal penetration were randomly divided into two groups (laparotomy and laparoscopic groups) using closed envelope technique for randomization. The following variables were then compared between the 2 groups: Operative time, postoperative pain using numerical rating system (NRS), length of postoperative hospital stay, wound complications, chest infection and missed injuries.Results: Based on the statistical analysis, it was found that the laparoscopy when used as a diagnostic tool is superior to laparotomy as regards the operative time and postoperative pain. As a therapeutic tool, laparoscopy was able to repair liver, stomach and diaphragmatic injuries and was superior to laparotomy regarding postoperative pain and length of hospital stay. Laparotomy had a higher rate of chest infection and wound infection with no statistical significance. Currently, the main drawbacks of laparoscopy are the technical challenges regarding bowel inspection and therapeutic procedures, which was reflected on the presence of converted cases in the study.