Penetrating anterior abdominal stab wounds: is exploratory laparotomy mandatory?

Background
Despite the consensus that patients with penetrating anterior abdominal stab wounds (AASWs) who presented with shock, diffuse peritonitis, or evisceration should be offered immediate laparotomy, the treatment of stable patients with negative abdominal examination is a bit controversial. It seems that selective nonoperative management (SNOM) of stable patients is picking up steam.
Aim
This study aimed to evaluate our experience in treating AASW patients and assess the safety and efficacy of the SNOM of AASWs.
Patients and methods
From March 2023 to October 2023, this study was conducted at the Aswan University Hospital's General Surgery Department. It involved 69 patients with penetrating AASWs. Group I: 31 hemodynamically stable patients who showed no signs of peritonitis underwent local wound exploration and were monitored with serial examinations. Group II: 38 individuals had evisceration, shock, and peritonitis treated by emergency laparotomy.
Results
Group I patients had successful nonoperative management in 83.87% of cases. The remaining 16% had delayed laparotomies, all of which were therapeutic. In group II, out of the 38 patients who had emergency laparotomies, 21% had unnecessary laparotomies. By combining selective management with diagnostic tests, we were able to bring the rate of unnecessary laparotomies down to zero. Complications occurred in 12.5% of patients who had an unnecessary laparotomy.
Conclusion
The SNOM of AASW patients who are asymptomatic or minimally symptomatic allows for a large reduction in unnecessary laparotomies.