Laparoscopic-assisted approach for penetrating abdominal trauma: A solution for multiple bowel injuries

Abstract Background Therapeutic laparoscopy (TL) for penetrating abdominal trauma (PAT) is controversial because the management of multiple bowel injuries is challenging and the conversion rate is high. However, the laparoscopic-assisted approach (LAA) allows easy management of multiple bowel injuries but not investigated in a trauma setting. The aim of this study was to investigate its role in management of multiple bowel injuries and to compare LAA with therapeutic laparoscopy performed fully laparoscopically (FTL). Methods All adult patients with PAT managed with TL over four-year period were analyzed. Intraoperative findings, trauma scoring, grading of bowel injuries, related procedures, outcomes and length of hospital stay (LOS) were compared between LAA and FTL groups. Results Seventy two (53%) patients were in the FTL group and 65 (47%) in the LAA group. The majority of patients presented with stab wounds. Colonic and small bowel injuries were more common in the LAA group (19 versus 17 and 47 versus 8, respectively). The higher number of bowel repairs, resections and anastomosis were performed in the LAA group. The ISS was higher in the FTL group (13 versus 11, p=0.02), and the PATI was higher in the LAA group (6 versus 10, p