Study: Surgery not mandatory for all gunshot wounds

Editor's Note

Selective nonoperative management of abdominal gunshot wounds is an acceptable and effective treatment for patients with less severe injuries that do not involve major organ damage or significant blood loss, this study finds.

Of 922 patients with abdominal gunshot wounds analyzed, 707 had an immediate laparotomy and 215 were managed nonoperatively.

Compared to the laparotomy group, the nonsurgery patients had a lower median Injury Severity Score (16 vs 8), lower incidence of complications (34.7% vs 8.5%) and mortality (5.2% vs 0.5%), and shorter ICU and hospital stays (1/8 vs 0/2).

Selective nonoperative management of abdominal gunshot wounds is safe and avoids unnecessary laparotomies, which may cause complications in the short and long term, the authors say. Trauma teams have become more comfortable with not operating on abdominal gunshot wounds because of the wider availability of sophisticated imaging technology.

Selective nonoperative management (SNOM) of abdominal gunshot wounds (aGSW) is being practiced in certain trauma centers, but its broader acceptance in the surgical community is unknown. We hypothesized that SNOM has been adopted in New England as an acceptable method of aGSW management.