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When to operate on abdominal gunshot wounds
1Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles 90033, USA.
Summary
Selective nonoperative management is increasingly successful for abdominal gunshot wounds, challenging mandatory exploration. This approach reduces complications and hospital stays, offering a viable alternative for trauma care.
Area of Science:
- Trauma Surgery
- Surgical Management
- Emergency Medicine
Background:
- Historically, penetrating abdominal trauma management evolved from expectant to operative care.
- Selective nonoperative management is standard for stab wounds but debated for abdominal gunshot wounds (GSWs).
- Mandatory exploration for GSWs is based on perceived high intra-abdominal injury rates.
Purpose of the Study:
- To review controversies surrounding selective nonoperative management (SNOM) of abdominal gunshot wounds.
- To present current experiences and approaches to SNOM for GSWs.
- To evaluate the efficacy and safety of SNOM in abdominal GSWs.
Main Methods:
- Literature review of historical and recent studies on penetrating abdominal trauma.
- Analysis of outcomes data for selective nonoperative management versus mandatory exploration.
- Presentation of institutional experience and current clinical practice.
Main Results:
- Recent series demonstrate successful outcomes with SNOM for abdominal GSWs.
- SNOM is associated with decreased morbidity and shorter hospital stays compared to mandatory exploration.
- Evidence suggests a lower incidence of intra-abdominal injuries than previously assumed for GSWs.
Conclusions:
- Selective nonoperative management is a safe and effective option for select patients with abdominal gunshot wounds.
- SNOM challenges the traditional approach of mandatory laparotomy for all abdominal GSWs.
- Further research and standardized protocols are needed to optimize SNOM for abdominal GSWs.