Laparoscopy versus laparotomy for pediatric patients with abdominal firearm injuries

Background: Current guidelines recommend exploratory laparotomy for pediatric patients with abdominal firearm injuries. This study compared clinical outcomes of hemodynamically stable pediatric patients with abdominal firearm injuries managed with laparoscopy versus laparotomy. Methods: A retrospective, intention-to-treat study was conducted using the Pediatric Trauma Quality Improvement Program database. Pediatric patients (age <20) with abdominal firearm injuries from 2010 to 2020 were sorted into laparotomy (n = 1806) and laparoscopy (n = 48) groups. Results: Laparoscopy was associated with lower complication rates (4.2% versus 21.1%, odds ratio [OR] 0.16, p = 0.002), fewer ICU stays (62.5% versus 77.4%, OR 0.49, p = 0.02), and fewer transfusions (35.4% versus 57.1%, OR 0.41, p = 0.003). There was no significant difference in infection rate, mortality rate, mean LOS, or mean ICU LOS. Conclusions: In select trauma patients, laparoscopy was associated with lower rates of complications, transfusions, and ICU stay.