Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort

Muzaffer Atlı; Okay Nazlı

doi:10.7197/cmj.1954888

EN TR

Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort

Abstract

Objective: To determine the rate of negative laparotomy in patients undergoing exploratory laparotomy for penetrating abdominal trauma during a period before routine computed tomography (CT)–based triage was integrated into the institutional pathway, and to compare clinical features and short-term outcomes between negative and therapeutic laparotomy groups.

Methods: In total, 189 consecutive patients who underwent exploratory laparotomy for penetrating abdominal trauma between January 1997 and August 2002 were retrospectively reviewed. Patients were classified by operative findings as negative laparotomy (NL) or therapeutic laparotomy (TL); the NL group combined strictly negative explorations and non-therapeutic laparotomies with only incidental findings. Injury mechanism, wound characteristics, preoperative diagnostic approach, postoperative complications, in-hospital mortality and length of hospital stay were compared between groups.

Results: NL occurred in 62/189 patients (32.8%; 95% CI 26.5–39.8) and TL in 127 (67.2%). Stab wounds accounted for 171 cases (90.5%) and gunshot wounds for 18 (9.5%). Mechanism, wound localization and wound number were not significantly associated with operative findings (p > 0.05). Local wound exploration alone was the most frequent diagnostic modality (131/189, 69.3%). Complications occurred in 1/62 NL (1.6%) and 8/127 TL (6.3%) patients (p = 0.276). All seven in-hospital deaths (3.7%) occurred in the TL group — five from exsanguinating vascular injury and two from late anastomotic leak. Median hospital stay was 5 days (IQR 4–6) in NL versus 7 days (IQR 6–9) in TL (p < 0.001).

Conclusion: About one third of laparotomies in this pre-CT-triage cohort were negative. Injury descriptors and the preoperative diagnostic approach did not clearly discriminate NL from TL in this dataset; TL was associated with longer hospitalization. All deaths occurred in the TL group and reflected severe vascular or intestinal injury. These data provide a local baseline for evaluating outcomes after CT-supported selective management.

Keywords

Supporting Institution

The authors received no specific funding for this work.

Ethical Statement

The study was originally conducted between 1997 and 2002 and analyzed as a postgraduate medical specialty thesis that was reviewed and approved through the thesis evaluation procedures applicable to specialty training research at the host training and research hospital at that time. Informed consent was not obtained due to the retrospective design of the study and the use of de-identified archived records.

Thanks

The authors thank the medical records department of their institution for their assistance in accessing the archived case files used in this study.

Rutin BT Tabanlı Triyaj Öncesi Penetran Karın Travmasında Negatif Laparotomi: Tek Merkezli Retrospektif Bir Kohort

Abstract

Amaç: Rutin bilgisayarlı tomografi (BT) tabanlı triyajın kurumsal yaklaşıma henüz entegre edilmediği bir dönemde penetran karın travması nedeniyle eksploratif laparotomi uygulanan hastalarda negatif laparotomi oranını belirlemek ve negatif ile terapötik laparotomi grupları arasındaki klinik özellikler ile kısa dönem sonuçları karşılaştırmaktır.

Gereç ve Yöntem: Ocak 1997 ile Ağustos 2002 tarihleri arasında penetran karın travması nedeniyle eksploratif laparotomi uygulanan 189 ardışık hasta retrospektif olarak incelendi. Hastalar operatif bulgulara göre negatif laparotomi (NL) veya terapötik laparotomi (TL) olarak sınıflandırıldı; NL grubu kesin negatif laparotomileri ve yalnız insidental bulgu içeren non-terapötik laparotomileri birlikte kapsamaktadır. Yaralanma mekanizması, yara özellikleri, preoperatif tanı yaklaşımı, postoperatif komplikasyonlar, hastane içi mortalite ve hastane yatış süresi gruplar arasında karşılaştırıldı.

Bulgular: 189 hastanın 62’sinde (%32,8; %95 GA 26,5–39,8) NL, 127’sinde (%67,2) TL saptandı. Hastaların 171’i (%90,5) kesici-delici alet, 18’i (%9,5) ateşli silah yaralanmasıydı. Mekanizma, yara lokalizasyonu ve yara sayısı ile operatif bulgular arasında anlamlı ilişki saptanmadı (p > 0,05). En sık preoperatif tanı yöntemi tek başına lokal yara eksplorasyonu idi (131/189, %69,3). Komplikasyon NL grubunda 1/62 (%1,6), TL grubunda 8/127 (%6,3) hastada gelişti (p = 0,276). Hastane içi mortalite 7/189 (%3,7) olup tüm ölümler TL grubundaydı; beşi majör vasküler yaralanma kanamasından, ikisi geç anastomoz kaçağı sepsisinden kaynaklandı. Medyan hastane yatış süresi NL grubunda 5 gün (IQR 4–6), TL grubunda 7 gün (IQR 6–9) idi (p < 0,001).

Sonuç: BT öncesi döneme ait bu kohortta laparotomilerin yaklaşık üçte biri negatifti. Yaralanma tanımlayıcıları ve preoperatif tanı yaklaşımı bu veri setinde NL’yi TL’den güvenilir biçimde ayırt etmedi; TL daha uzun hastane yatışı ile ilişkili bulundu. Tüm ölümler TL sonrasında oldu ve ağır vasküler ya da intestinal yaralanmaları yansıttı. Bu veriler, BT destekli seçici yönetim sonrası elde edilecek sonuçların karşılaştırılması için yerel bir başlangıç noktası sağlar.

Keywords

Supporting Institution

Yazarlar bu çalışma için herhangi bir özel finansal destek almamıştır.

Ethical Statement

Bu çalışma ilk olarak 1997–2002 yılları arasında yürütülmüş ve ilgili dönemde uzmanlık eğitimi araştırmaları için geçerli olan tez değerlendirme süreçleri kapsamında incelenip kabul edilmiş bir tıpta uzmanlık tezi olarak analiz edilmiştir. Çalışmanın retrospektif tasarımı ve kimlik bilgileri çıkarılmış arşiv kayıtlarının kullanılması nedeniyle bilgilendirilmiş onam alınmamıştır.

Thanks

Yazarlar, bu çalışmada kullanılan arşiv hasta dosyalarına erişim konusundaki katkılarından dolayı kurumun tıbbi kayıt birimine teşekkür eder.

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Details

Primary Language

English

Subjects

Health Services and Systems (Other)

Journal Section

Research Article

Authors

Muzaffer Atlı ^*
0009-0007-4376-8289
Türkiye

Okay Nazlı
0000-0001-8500-5510
Türkiye

Publication Date

September 30, 2026

Submission Date

May 19, 2026

Acceptance Date

July 24, 2026

Published in Issue

Year 2026 Volume: 48 Number: 3

DOI

https://doi.org/10.7197/cmj.1954888

IZ

https://izlik.org/JA25RU89SH

Cite

RIS / Bibtex

APA

Atlı, M., & Nazlı, O. (2026). Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort. Cumhuriyet Medical Journal, 48(3), 112-119. https://doi.org/10.7197/cmj.1954888

AMA

1.Atlı M, Nazlı O. Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort. CMJ. 2026;48(3):112-119. doi:10.7197/cmj.1954888

Chicago

Atlı, Muzaffer, and Okay Nazlı. 2026. “Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort”. Cumhuriyet Medical Journal 48 (3): 112-19. https://doi.org/10.7197/cmj.1954888.

EndNote

Atlı M, Nazlı O (September 1, 2026) Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort. Cumhuriyet Medical Journal 48 3 112–119.

IEEE

[1]M. Atlı and O. Nazlı, “Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort”, CMJ, vol. 48, no. 3, pp. 112–119, Sept. 2026, doi: 10.7197/cmj.1954888.

ISNAD

Atlı, Muzaffer - Nazlı, Okay. “Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort”. Cumhuriyet Medical Journal 48/3 (September 1, 2026): 112-119. https://doi.org/10.7197/cmj.1954888.

JAMA

1.Atlı M, Nazlı O. Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort. CMJ. 2026;48:112–119.

MLA

Atlı, Muzaffer, and Okay Nazlı. “Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort”. Cumhuriyet Medical Journal, vol. 48, no. 3, Sept. 2026, pp. 112-9, doi:10.7197/cmj.1954888.

Vancouver

1.Muzaffer Atlı, Okay Nazlı. Negative Laparotomy in Penetrating Abdominal Trauma Before Routine CT-Based Triage: A Single-Center Retrospective Cohort. CMJ. 2026 Sep. 1;48(3):112-9. doi:10.7197/cmj.1954888