Background: Abdominal trauma is one of the leading causes of death. In Colombia, few studies have evaluated the results on related factors and outcomes when comparing laparotomy versus laparoscopy in the management of penetrating abdominal trauma. Therefore, the aim of this study was to investigate the feasibility and safety of laparoscopy in the treatment of stable penetrating abdominal trauma in a limited resources environment in a middle-income country.Methods: Retrospective cross-sectional study was conducted in Bogota, Colombia from January 2018 to October 2020. Patients over 18 years old, hemodynamically stable with penetrating abdominal trauma without other body parts injuries, that underwent laparoscopy and/or laparotomy surgical exploration and treatment were included. Frequencies, percentages, correlations, and odds ratio were calculated.Results: A total of 52 patients were analyzed (26 laparoscopy vs. 26 laparotomy).Stabbing injuries were more frequent in both groups (76.9%), as well as involvement of the anterior abdomen. None missed enterotomies were reported in the laparoscopy group. Surgical time and bleeding were significantly lower in the laparoscopic approach group (63 vs. 115 min and 65 vs. 992 cc, respectively).The time to oral intake and length of stay in the intensive care unit was significantly shorter in the laparoscopic management group (2 vs. 3 days and 1 vs. 4 days, respectively).Conclusions: Surgical results found a safe scenario in a limited resources environment for the application of the laparoscopic technique to approach penetrating abdominal trauma in stable patients without missed injuries, low threshold of conversion to open approach, and additionally not presenting a higher percentage of complications compared with the laparotomy group in Colombia.
Introduction
Penetrating chest trauma (PCT) represents 10% of worldwide mortality, with developing countries counting as some of the most affected by high mortality rates due to cardiac trauma. Colombia is considered one of the most violent countries due to the high mortality rate associated with war and crime, hence the validation of an own classification for penetrating cardiac injuries (PCI) is mandatory.
Methods
Retrospective cross‐sectional study which included adult patients with PCIs at a level 4 trauma center in Colombia, between January 2018 and April 2020. We used our own system (Bogotá Classification) and compared it with traditional systems (e.g., Ivatury's, OIS‐AAST), by analyzing the mechanism of injury (MOI), the hemodynamic status of the patient at admission, the inpatient management, the individual outcomes, and some demographic variables. Bivariate statistical analysis, spearman correlation, and logistic regression were performed.
Results
Four hundred and ninety‐nine patients were included. Bivariate analysis demonstrated a significant relationship between mortality and hemodynamic state, MOI, its location and degree of lesion, cardiac/vessel injury, cardiac tamponade, time between injury and medical care, fluid reanimation, as well as the Ivatury's classification and the new classification (p < 0.005). The adequate correlation between Ivatury's and Bogotá classification supports the latter's clinical utility for patients presenting with PCI. Likewise, logistic regression showed a statistically significant association among mortality rates (p < 0.005).
Conclusions
The Bogotá classification showed similar performance to the Ivatury's classification, correlating most strongly with mortality. This scale could be replicated in countries with similar social and economic contexts.
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