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Laparotomy for penetrating gastric trauma - A South African experience
Natalie Allen1, Victor Kong2, Cynthia Cheung3
1Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
Insights
Primary repair is effective for penetrating gastric injuries (PGI). However, surgeons must remain vigilant for unidentified injuries during laparotomy, as these are common and impact patient outcomes.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Penetrating gastric injury (PGI) management involves contentious peri-operative aspects.
- Primary repair is generally sufficient for most gastric injuries.
- This study evaluates PGI management and outcomes at a South African trauma center.
Purpose of the Study:
- To review the clinical experience and outcomes of patients with penetrating gastric injuries.
- To identify challenges and areas for improvement in the peri-operative management of PGI.
Main Methods:
- Retrospective study of 210 patients with PGI from January 2012 to April 2020.
- Analysis of injury mechanisms (stab wounds vs. gunshot wounds), injury severity, complications, and outcomes.
- Primary repair was the universal surgical approach.
Main Results:
- Stab wounds (59%) and gunshot wounds (41%) were the primary mechanisms.
- 20% of injuries were isolated gastric injuries; 5% had unidentified injuries post-laparotomy.
- Gunshot wounds were associated with higher injury severity, longer hospital stays, increased ICU admissions, and greater morbidity/mortality compared to stab wounds.
Conclusions:
- Primary repair is adequate for the majority of penetrating gastric injuries.
- Laparotomy for PGI carries a significant risk of unidentified injuries, requiring surgeon awareness.
- Gunshot wounds present a greater management challenge than stab wounds.
Introduction:
Penetrating gastric injury (PGI) is common and although primary repair is sufficient for most injuries, several areas surrounding the peri-operative management remain contentious. This study reviews our experience in the management of PGI and review the clinical outcome at a major trauma centre in South Africa.
Materials And Methods:
A retrospective study was conducted from January 2012 to April 2020 at a major trauma centre in South Africa.
Results:
210 cases were included (184 male, median age: 30 years). Mechanism of injury was 59% stab wounds (SWs) and 41% gunshot wounds (GSWs). The AAST grade was predominantly (92%) grade 2 for all cases. 20% (41/210) were isolated gastric injuries. All cases underwent primary repair and there were no cases of suture line failure. Eleven cases (5%) had one or more injuries not identified at the index laparotomy: 7 were unidentified gastric injuries and the remaining 4 were unidentified non gastric injuries. There was no association between unidentified injuries and mechanism of injury or outcome. Fifty-seven (27%) cases experienced one or more complications. Eighty-two cases (39%) required intensive care unit admission. The overall median length of hospital stay was 7 (IQR 4-11) days. The overall mortality was 14%. GSW injuries were more likely to have additional organ injury, higher ISS and PATI scores, longer length of hospitalization, higher likelihood of ICU stay, greater morbidity and mortality than SW injuries. There was a slight increase in the wound sepsis rate as number of associated extra gastric injuries increased but this was not statistically significant. There was no difference in wound overall sepsis rate between SW and GSW injuries (2% vs 8%, p=0.121).
Conclusions:
Primary repair alone is sufficient for most PGI, but laparotomy is associated with high incidence of unidentified injury and surgeons must to be cognisant of the likelihood of these occult injuries.
