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European Journal of Trauma and Emergency Surgery

Erschienen in:

18.08.2022 | Original Article

Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

verfasst von: Supreet Kaur, Dinesh Bagaria, Abhinav Kumar, Pratyusha Priyadarshini, Narendra Choudhary, Sushma Sagar, Amit Gupta, Biplap Mishra, Mohit Joshi, Atin Kumar, Shivanand Gamanagatti, Kapil Dev Soni, Richa Aggarwal, Sreenivas Vishnubhatla, Subodh Kumar

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2023

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Abstract

Purpose

Penetrating abdominal trauma was traditionally managed by mandatory exploration, which led to high rates of non-therapeutic surgery and prolonged hospital stay. Diagnostic laparoscopy (DL) is a less-invasive alternative; however, it requires general anaesthesia and carries a potential risk of iatrogenic injuries. Contrast-enhanced computed tomography (CECT)-guided selective non-operative management (SNOM) may avoid surgery altogether, but there is apprehension of missed injury. Randomised trials comparing these two modalities are lacking. This study is aimed at comparing outcomes of these two management approaches.

Methods

Hemodynamically stable patients with penetrating trauma to anterior abdominal wall were randomised in 1:1 ratio to DL or CECT-based management. Primary outcome was length of hospital stay (LOS). Secondary outcomes were rate of non-therapeutic surgery, complications, and length of intensive care unit (ICU) stay.

Results

There were 52 patients in DL group and 54 patients in CECT group. Mean LOS was comparable (3 vs 3.5 days; p = 0.423). Rate of non-therapeutic surgery was significantly lower in CECT group (65.4 vs 17.4%, p = 0.0001). Rate of complications and length of ICU stay were similar. Selective non-operative management based on CECT findings was successful in 93.8% of patients; 2 patients had delayed surgery.

Conclusion

In patients with penetrating trauma to anterior abdominal wall, DL and CECT-based management led to comparable hospital stay. Significant reduction in non-therapeutic surgery could be achieved using a CECT-based approach.

Trial registration

Clinical trials registry-India (CTRI/2019/04/018721, REF/2019/01/023400).

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Titel: Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial
verfasst von: Supreet Kaur
Dinesh Bagaria
Abhinav Kumar
Pratyusha Priyadarshini
Narendra Choudhary
Sushma Sagar
Amit Gupta
Biplap Mishra
Mohit Joshi
Atin Kumar
Shivanand Gamanagatti
Kapil Dev Soni
Richa Aggarwal
Sreenivas Vishnubhatla
Subodh Kumar
Publikationsdatum: 18.08.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 1/2023
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02089-5

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Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial