DOI: 10.7197/cmj.1954888 ISSN: 1305-0028

Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort

Muzaffer Atlı, Okay Nazlı
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Objective: To determine the rate of negative laparotomy in patients undergoing exploratory laparotomy for penetrating abdominal trauma during a period before routine computed tomography (CT)–based triage was integrated into the institutional pathway, and to compare clinical features and short-term outcomes between negative and therapeutic laparotomy groups.Methods: In total, 189 consecutive patients who underwent exploratory laparotomy for penetrating abdominal trauma between January 1997 and August 2002 were retrospectively reviewed. Patients were classified by operative findings as negative laparotomy (NL) or therapeutic laparotomy (TL); the NL group combined strictly negative explorations and non-therapeutic laparotomies with only incidental findings. Injury mechanism, wound characteristics, preoperative diagnostic approach, postoperative complications, in-hospital mortality and length of hospital stay were compared between groups.Results: NL occurred in 62/189 patients (32.8%; 95% CI 26.5–39.8) and TL in 127 (67.2%). Stab wounds accounted for 171 cases (90.5%) and gunshot wounds for 18 (9.5%). Mechanism, wound localization and wound number were not significantly associated with operative findings (p > 0.05). Local wound exploration alone was the most frequent diagnostic modality (131/189, 69.3%). Complications occurred in 1/62 NL (1.6%) and 8/127 TL (6.3%) patients (p = 0.276). All seven in-hospital deaths (3.7%) occurred in the TL group — five from exsanguinating vascular injury and two from late anastomotic leak. Median hospital stay was 5 days (IQR 4–6) in NL versus 7 days (IQR 6–9) in TL (p < 0.001).Conclusion: About one third of laparotomies in this pre-CT-triage cohort were negative. Injury descriptors and the preoperative diagnostic approach did not clearly discriminate NL from TL in this dataset; TL was associated with longer hospitalization. All deaths occurred in the TL group and reflected severe vascular or intestinal injury. These data provide a local baseline for evaluating outcomes after CT-supported selective management.

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