Qualité de vie et complications après laparotomie pour plaie pénétrante abdominale : étude autour de 34 cas sur l'hôpital d'instruction des armées Laveran à Marseille

Abstract : Introduction: Injuries are the fourth leading cause of death in Europe. Laparotomy is the standard treatment for penetrating abdominal wounds. Because of the morbidity and the high rate of negative laparotomies, the nonoperative treatment is effectively developing. The aim of this study is to analyze the complications and the quality of life of the patients after laparotomy for this kind of wounds, and thus specify the place of the nonoperative treatment. Patients and methods: A retrospective monocentric cohort of patients was studied between 2007 and 2016 at the Laveran hospital in Marseille. One hundred and eighty-six trunk wounds with firearms or knives were recorded, including 74 abdominal wounds. Thirty-four patients were included in this study, after analysis records to objectivize the penetrating nature of the wound, and the management by laparotomy. The patients and their referring general practitioners were contacted to complete missing datas and the SF-12 quality of life score. Results: Among the 34 patients included, the average age was 39 years and most of them were men. The indication for laparotomy was mainly based on the hemodynamic instability, then according to the results of the computerized tomography scanners in case of suspicion of organ lesions : digestive tract, vessels, diaphragm. Only 5 laparotomies were negative. Eleven complications after laparotomy were found (32.4%), including 7 early (within the 30 days) and 4 late. No complication were found after negative or non-therapeutic laparotomies. Eventually, the quality of life of the patients after one year is similar to those of the general population. Conclusion: The most common indication for laparotomy for abdominal wound is the hemodynamic instability. The rate of laparotomy complications for penetrating abdominal trauma is similar to those of scheduled surgeries. The quality of life after this care remains unchanged. These results may insist on the fact that the “gold standard” treatment for penetrating abdominal injury remains the laparotomy.
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Mathieu Senra. Qualité de vie et complications après laparotomie pour plaie pénétrante abdominale : étude autour de 34 cas sur l'hôpital d'instruction des armées Laveran à Marseille. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02047840⟩

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