Revisiting surgical decisions: The choice between laparotomy and laparoscopy for traumatic small bowel injuries

Background: Although laparoscopy has gained popularity in abdominal trauma management, its role in treating traumatic small bowel injuries remains controversial, particularly in critically ill patients. The present study aimed to assess the feasibility and outcomes of laparoscopic surgery in comparison with laparotomy for traumatic small bowel injuries, especially among high-risk subgroups. Methods: This was a retrospective cohort study based on data from the Trauma Quality Improvement Program database between 2021 and 2022. Patients with small bowel injury who underwent operative management were included. Clinical data of patients who underwent laparotomy were compared with those who underwent laparoscopic surgeries. Subgroup analyses were performed on the older patients, severely injured patients, and patients with unstable hemodynamics. Factors associated with poor outcomes in patients who underwent laparoscopy were also analyzed using logistic regression. Results: Of the 9,593 patients, 234 (2.4%) underwent laparoscopic surgery for small bowel injuries. No differences in the injury site or surgical procedure performed were observed between the patients who underwent laparotomy and those who underwent laparoscopy. No significant differences were found between elderly or hemodynamically unstable patients who underwent laparotomy or laparoscopy in terms of hospital stay, mortality rate, or surgery-associated complications. Among patients who underwent laparoscopic surgery, those with unstable hemodynamics (odds = 5.846, P < .001) and severe injuries (odds = 3.322, P = .010) had higher risks of surgical complications. Conclusion: Despite traditional concerns, surgeons may consider a more assertive use of laparoscopy in trauma settings.