Laparoscopic Versus Open Surgery for Penetrating and Blunt Abdominal Trauma: A Systematic Review and Meta-Analysis

Exploratory laparotomy (EL) is the standard approach for managing abdominal trauma; however, it is associated with significant morbidity and high rates of non-therapeutic interventions. While laparoscopy is utilized to mitigate these risks, its therapeutic role and comparative safety profile, particularly in blunt trauma, remain controversial. This systematic review and meta-analysis compared the clinical outcomes of laparoscopic versus open surgery in hemodynamically stable patients with penetrating and blunt abdominal trauma. A systematic search of MEDLINE, Embase, CENTRAL, CINAHL, and Scopus was conducted from January 1990 to February 2026, adhering to PRISMA 2020 guidelines (PROSPERO: CRD420261296724). Comparative studies (randomized controlled trials and observational cohorts) evaluating laparoscopy versus open laparotomy in adult and pediatric trauma patients were included. The primary outcomes were mortality and length of hospital stay (LOS); secondary outcomes included overall complications and conversion rates. Random-effects models with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustments were used for pooling. Subgroup analysis, meta-regression, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were performed. Fifteen studies comprising 22,242 patients (3,965 laparoscopic and 18,277 open) were included. The laparoscopic approach was associated with a significant reduction in hospital LOS (mean difference (MD) -3.55 days; 95% confidence interval (CI): -4.92 to -2.18; p < 0.001; GRADE: moderate). Patients undergoing laparoscopy demonstrated 52% lower odds of mortality (odds ratio (OR) 0.48; 95% CI: 0.18 to 1.30; p = 0.12; GRADE: low) and a 55% reduction in overall postoperative complications (OR 0.45; 95% CI: 0.34 to 0.60; p < 0.001; GRADE: low), although these findings were susceptible to selection bias. Subgroup analyses confirmed that the reduction in LOS remained significant across both penetrating and blunt injury mechanisms. The pooled conversion rate from laparoscopy to open surgery was 18.6%. Leave-one-out sensitivity analyses and cumulative meta-analysis demonstrated the robustness and temporal stability of the treatment effect. In appropriately selected, hemodynamically stable patients with abdominal trauma, laparoscopy is a safe and highly effective alternative to open laparotomy. It significantly reduces hospital LOS and postoperative morbidity without increasing mortality, proving efficacious for both penetrating and blunt injury mechanisms. These findings support the integration of a laparoscopic-first approach as a standard of care in modern trauma algorithms.