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Background: Presently, non-operative management of penetrating abdominal stab injuries has been standardized in several trauma centers. This strategy has appromising outcome conserving decreasing morbidity. Aim of the work: This study aimed to assess the safety and feasibility of SNOM of patients having penetrating abdominal stab injuries not indicating emergent laparotomy and  to identify a protocol for selection of patient candidates for non-operative management in a tertiary care hospital in Egypt. Patients & Methods: This is a prospective study that involved patients who presented to the casualty department of Kasr Elainy teaching Hospital, in the period from August 2018 to August 2020, for management of a penetrating abdominal Stab injuries. Fully conscious, haemodynimacally stable patients were included. Eligible patients were allocated to either SNOM group or immediate operative management (IOM) group. Results: SNOM group included64 patients and IOM group included 40 patients. The age of the patients ranged from 16 to 49 years with a mean of 33±6.8 years, and the majority were males (99%). SNOM failed in 4/69 patients (5.7%) who required delayed laparotomy for peritonitis (2 cases) and HB drop and haemodynamic instability (2 cases). In IOM group, only 3 cases had therapeutic laparotomies (7.3%). The remaining cases had unnecessary laparotomies (92.7%). Statistically significant higher LOS was seen in SNOM group (p<0.05). However, less unnecessary laparotomies and lower incidences of complications were noted (p<0.01). Conclusion: vital signs together with abdominal examination are the most important clinical criteria in decision making in penetrating abdominal stab injury patients  When surgery is not absolutely indicated, SNOM is a safe and feasible approach in management of penetrating abdominal stab injury by following proper management algorithm and selection criteria.

Background: The presence of defects in native umbilical in adults and its use as laparoscopic first entry site is poorly documented. It would likely be a safer method than the Veress needle and direct trocar insertion. This work aimed to report the prevalence and size of native umbilical defects, and their relationship with gender, age and body mass index. Methods: In 160 consecutive laparoscopic operations, a trans-umbilical incision was made and a defect at its base was looked for. When found, the defect was measured and used as the first port entry site. Relationships of presence of native defects and their sizes in relation to gender, age and BMI were analyzed. Results: The prevalence of a native defect in this series was 90%. Its presence had no relation with gender, age or BMI. Its size, however, positively correlated with age and BMI. No complications were related to the defect’s use for first laparoscopic entry site. Conclusion: A native umbilical defect is present in 90% of adults. Whenever present, it is recommended for use as the first port entry site by an open technique. This method is simple and safe and avoids unnecessarily inducing another defect. Keywords: Laparoscopy, Open technique, Access, Native defect, Umbilical defect

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