CHAPTER 89 LAPAROTOMY IN ABDOMINAL GUNSHOT WOUNDS

Selective Nonoperative Management in 1,856 Patients with Abdominal Gunshot Wounds: Should Routine Laparotomy Still be the Standard of Care?

Velmahos GC, Demetriades D, Toutouzas KG, et al. Ann Surg. 2001;234(3):395–402

BACKGROUND

Abdominal gunshot wounds (GSWs) are a frequent and high-mortality injury seen in many EDs. Traditional practice in most trauma centers for these injuries has been routine laparotomy due to a perceived high incidence of significant intra-abdominal injury, the supposed harmless nature of a laparotomy, and the unreliability of physical examination. Prior to this study, selective nonoperative management in patients with blunt trauma and penetrating stab wounds had been shown to be safe and cost effective; however, no evidence existed to support this approach in GSW patients.

OBJECTIVES

To describe the experience of 8 years of a selective nonoperative management protocol in abdominal GSW patients and to evaluate its effect on safety, cost, efficiency, and length of stay.

METHODS

Retrospective observational study conducted in a single Level I trauma center in the US between 1993 and 2000.

Participants

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