ABDOMINAL TRAUMA IN PEDIATRICS: DECISION-MAKING BETWEEN LAPAROTOMY AND CONSERVATIVE MANAGEMENT
DOI:
https://doi.org/10.56238/levv16n55-080Keywords:
Abdominal Injuries, Child, Laparotomy, Conservative TreatmentAbstract
Introduction: Abdominal trauma represents a major cause of morbidity and mortality in children, and determining whether operative or conservative management is most appropriate remains a critical challenge in modern pediatric trauma care. The decision is complicated by age-specific anatomical characteristics, variable hemodynamic responses, and evolving diagnostic modalities.
Objective: The main objective of this review is to evaluate current evidence regarding decision-making between laparotomy and conservative management in pediatric abdominal trauma. Secondary objectives include analyzing outcomes associated with each strategy, assessing organ-specific considerations, evaluating complication profiles, reviewing predictors of failure of nonoperative management, and identifying gaps for future research.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the WHO ICTRP. Studies published in the last five years were eligible, with extension to ten years only if fewer than ten studies met criteria. Human studies were prioritized, while animal or in vitro evidence was cataloged separately when relevant. Two independent reviewers screened titles, abstracts, and full texts using PRISMA methodology. Data extraction followed a standardized form, and risk of bias was assessed using RoB 2, ROBINS-I, or QUADAS-2 as appropriate. Certainty of evidence was graded using the GRADE approach.
Results and Discussion: A total of 18 studies met the inclusion criteria and were analyzed. The evidence suggests that conservative management is safe and effective in hemodynamically stable children, particularly for solid organ injuries, while laparotomy remains essential in cases with clear signs of peritonitis, uncontrolled hemorrhage, or failed nonoperative treatment. Across studies, variability in imaging protocols, injury grading, and institutional thresholds for surgery contributed to heterogeneity.
Conclusion: Current evidence supports a selective approach in which nonoperative management is preferred for stable pediatric patients, and laparotomy is reserved for specific complications or clinical deterioration. Standardization of diagnostic pathways, injury grading, and monitoring protocols may improve outcomes and reduce unnecessary surgeries. Future research should emphasize multicenter prospective designs and uniform reporting standards.
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